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  • Question 1 - A 3-year-old boy has been brought to the hospital by his mother with...

    Correct

    • 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: 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
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  • Question 2 - A 70-year-old man presents to the emergency department acutely unwell. He is shocked,...

    Incorrect

    • A 70-year-old man presents to the emergency department acutely unwell. He is shocked, drowsy and confused.
      He is known to be type-2 diabetic maintained on metformin.
      Blood tests reveal a metabolic acidosis with an anion gap of 24 mmol/l. Ketones are not significantly elevated and random blood glucose was 8.7 mmol/l.
      What is the mainstay of treatment for this condition?

      Your Answer:

      Correct Answer: Rehydration

      Explanation:

      Lactic acidosis is occasionally responsible for metabolic acidosis in diabetics. It may occur in the presence of normal blood levels of the ketone bodies, and such cases are often described as having “non-ketotic diabetic acidosis.
      It is most commonly associated with tissue hypoperfusion and states of acute circulatory failure.
      Appropriate measures include treatment of shock, restoration of circulating fluid volume, improved cardiac function, identification of sepsis source, early antimicrobial intervention, and resection of any potential ischemic regions. Reassessment of lactate levels for clearance assists ongoing medical management.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 3 - A 30 yr. old male, who is the brother of a patient with...

    Incorrect

    • A 30 yr. old male, who is the brother of a patient with hypertrophic cardiomyopathy has come for the screening. Which of the following is the most appropriate method of screening?

      Your Answer:

      Correct Answer: Echocardiography

      Explanation:

      12-lead electrocardiography and transthoracic echocardiography are recommended as a screening method for family members of patients with HCM.

    • This question is part of the following fields:

      • Cardiology
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  • Question 4 - A 75-year-old woman experiences weakness of her left hand. Clinical examination reveals wasting...

    Incorrect

    • A 75-year-old woman experiences weakness of her left hand. Clinical examination reveals wasting of the hypothenar eminence and weakness of finger abduction and thumb adduction. The lesion is most probably located at:

      Your Answer:

      Correct Answer: Ulnar nerve

      Explanation:

      Patients with compressive neuropathy of the ulnar nerve typically describe numbness and tingling of the ulnar-sided digits of the hand, classically in the small finger and ulnar aspect of the ring finger. Among the general population, symptoms usually begin intermittently and are often worse at night, particularly if the elbow is flexed while sleeping. As the disease progresses, paraesthesia may occur more frequently and during the daytime.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 5 - A 24 year old female, 28 weeks pregnant presents to the clinic complaining...

    Incorrect

    • A 24 year old female, 28 weeks pregnant presents to the clinic complaining of shortness of breath and right sided pleuritic chest pain. The doctor suspects pulmonary embolism.
      Which of the following statement is incorrect regarding the management of this case?

      Your Answer:

      Correct Answer:

      Explanation:

      V/Q scanning carries a slightly increased risk of childhood cancer compared with CTPA – 1/280,000 versus less than 1/1,000,000 – but carries a lower risk of maternal breast cancer. The rest of the options are true.

    • This question is part of the following fields:

      • Respiratory
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  • Question 6 - A 55-year-old man with a three-year history of type 2 diabetes comes to...

    Incorrect

    • A 55-year-old man with a three-year history of type 2 diabetes comes to the clinic for review. He is currently managed with metformin 1 g BD and feels that his home blood glucose monitoring has deteriorated over the past few months. There is a history of hypertension and dyslipidaemia for which he takes Ramipril 10 mg daily and atorvastatin 20 mg.
      On examination, his BP is 155/82 mmHg, his pulse is 71 and regular. His chest is clear. His BMI is 32.

      Investigations show:
      Haemoglobin 12.9 g/dl (13.5 – 17.7),
      White cell count 5.0 x109/l (4 – 11),
      Platelets 180 x109/l (150 – 400),
      Sodium 140 mmol/l (135 – 146),
      Potassium 5.0 mmol/l (3.5 – 5),
      Creatinine 123 mmol/l (79 – 118),
      HbA1c 8.0% (<7.0).

      He would like to start sitagliptin.
      Which of the following adverse effects would you warn him about?

      Your Answer:

      Correct Answer: Pancreatitis

      Explanation:

      Sitagliptin-induced pancreatitis can occur at any time after the initiation of therapy, even after several years. Patients taking sitagliptin who present with signs and symptoms of mild or severe pancreatitis should immediately discontinue sitagliptin and use an alternate medication regimen for control of type 2 diabetes.
      In response to pancreatitis reported in post-marketing surveillance through the Adverse Event Reporting System (AERS), the FDA has issued revised prescribing information for sitagliptin stating that cases of acute pancreatitis have been reported with use, to monitor closely for signs and symptoms of pancreatitis, and to use sitagliptin with caution in patients with a history of pancreatitis.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 7 - A 69-year-old woman is admitted with confusion. She's known to have a history...

    Incorrect

    • A 69-year-old woman is admitted with confusion. She's known to have a history of multiple myeloma. Blood exam reveals the following: Na+ = 147 mmol/l, K+ = 4.7 mmol/l, Urea = 14.2 mmol/l, Creatinine = 102 μmol/l, Adjusted calcium = 3.9 mmol/l. What is the single most appropriate management?

      Your Answer:

      Correct Answer: IV 0.9% saline

      Explanation:

      NICE guidelines on hypercalcemia recommend that maintaining good hydration equals drinking 3-4 L of fluid/day, provided there are no contraindications. A low calcium diet is not necessary because intestinal absorption of calcium is reduced. The patient should avoid any other drugs or vitamins that could worsen the hypercalcemia. Mobilization is encouraged and any symptoms of hypercalcemia should be reported.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 8 - A 55-year-old lady, known with rheumatoid arthritis, complains of increasing numbness and tingling...

    Incorrect

    • A 55-year-old lady, known with rheumatoid arthritis, complains of increasing numbness and tingling in her feet and hands. She has recently developed an ulcer on her left heel, after having burnt her foot in a hot bath. A number of depigmented areas are readily seen over her upper limbs.

      She is currently taking low-dose prednisolone (7.5 mg daily), alendronic acid, lansoprazole, paracetamol, indomethacin, methotrexate and rituximab.

      Her blood tests demonstrate:
      Haemoglobin 9.9 g/l,
      MCV 102 fl,
      Platelets 410 x 109/L,
      White blood cells 12.3 x 109/L,
      Vitamin B12 97 pg/ml,
      Folate 12.3ng/ml,
      Random blood glucose 9.9 mmol/L,
      Thyroid-stimulating hormone 4.7 mU/ml,
      Thyroxine 12.8 pmol/L.

      Which autoantibody would be most diagnostic for the underlying disease?

      Your Answer:

      Correct Answer: Anti-intrinsic factor (IF)

      Explanation:

      This clinical scenario describes pernicious anaemia. Anti-intrinsic factor (IF) antibodies are most specific for pernicious anaemia. Antigastric parietal cell antibodies have a higher sensitivity but are less specific for pernicious anaemia. The other antibodies listed are not related to pernicious anaemia. Anti-TTG is seen with Celiac’s disease, anti-TPO is seen with thyroid disease, GAD is seen with type I diabetes, but this does not explain her anaemia.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 9 - A woman with severe renal failure undergoes a kidney transplant. However, after a...

    Incorrect

    • A woman with severe renal failure undergoes a kidney transplant. However, after a few hours, she develops fever and anuria. The doctors are suspecting hyperacute organ rejection. Which are the cells primarily responsible for hyperacute organ rejection?

      Your Answer:

      Correct Answer: B Cells

      Explanation:

      Hyperacute rejection appears in the first minutes following transplantation and occurs only in vascularized grafts. This very fast rejection is characterized by vessel thrombosis leading to graft necrosis. Hyperacute rejection is caused by the presence of antidonor antibodies existing in the recipient before transplantation. These antibodies induce both complement activation and stimulation of endothelial cells to secrete Von Willebrand procoagulant factor, resulting in platelet adhesion and aggregation. The result of these series of reactions is the generation of intravascular thrombosis leading to lesion formation and ultimately to graft loss. Today, this type of rejection is avoided in most cases by checking for ABO compatibility and by excluding the presence of antidonor human leukocyte antigen (HLA) antibodies by cross-match techniques between donor graft cells and recipient sera. This type of rejection is also observed in models of xenotransplantation of vascularized organs between phylogenetically distant species when no immunosuppressive treatment is given to the recipients.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 10 - 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 11 - A 19-year-old female is admitted with a headache, photophobia, fever and confusion. She...

    Incorrect

    • A 19-year-old female is admitted with a headache, photophobia, fever and confusion. She is managed with antibiotics. What is the mechanism of action of the most commonly used first line antibiotic class?

      Your Answer:

      Correct Answer: Inhibition of cell wall synthesis

      Explanation:

      In adults, the most common symptom of meningitis is a severe headache, occurring in almost 90% of cases of bacterial meningitis, followed by nuchal rigidity (the inability to flex the neck forward passively due to increased neck muscle tone and stiffness). Other signs commonly associated with meningitis include photophobia (intolerance to bright light) and phonophobia (intolerance to loud noises).
      In the United Kingdom empirical treatment consists of a third-generation cefalosporin such as cefotaxime or ceftriaxone. In the USA, where resistance to cefalosporins is increasingly found in streptococci, addition of vancomycin to the initial treatment is recommended. Penicillins, cephalosporins, carbapenems and monobactams all act via inhibition of cell wall synthesis.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 12 - A 60 yr. old man presented with severe central chest pain for the...

    Incorrect

    • A 60 yr. old man presented with severe central chest pain for the last 2 hours. He was on insulin for diabetes mellitus and he was dependent on haemodialysis because of end stage renal failure. He had undergone haemodialysis 48 hours prior to this presentation. His ECG showed an acute inferior myocardial infarction. Despite thrombolysis and other appropriate treatment, he continued to have chest pain after 6 hours from the initial presentation. His blood pressure was 88/54 mmHg and he had bibasal crepitations. His investigation results are given below.
      Serum sodium 140 mmol/l (137-144),
      Serum potassium 6.6 mmol/l (3.5-4.9),
      Serum urea 50 mmol/l (2.5-7.5),
      Serum creatinine 940 μmol/l (60-110),
      Haemoglobin 10.2g/dl (13.0-18.0),
      Troponin T >24 g/l (<0.04),
      Left ventricular ejection fraction was 20%.

      What is the most appropriate management for this patient?

      Your Answer:

      Correct Answer: Coronary angiography and rescue PCI

      Explanation:

      According to the history the patient has cardiogenic shock and pulmonary oedema. On-going ischaemia is indicated by persisting symptoms. So the most appropriate management is coronary angiography and rescue PCI. There are no indications for blood transfusion at this moment and it will aggravate the pulmonary oedema. Haemodialysis, beta blockers and furosemide cannot be given due to low blood pressure.

    • This question is part of the following fields:

      • Cardiology
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  • Question 13 - From the options provided below, which intervention plays the greatest role in increasing...

    Incorrect

    • From the options provided below, which intervention plays the greatest role in increasing survival in patients with COPD?

      Your Answer:

      Correct Answer: Smoking cessation

      Explanation:

      Smoking cessation is the most effective intervention in stopping the progression of COPD, as well as increasing survival and reducing morbidity. This is why smoking cessation should be the top priority in the treatment of COPD. Long term oxygen therapy (LTOT) may increase survival in hypoxic patients. The rest of the options dilate airways, reduce inflammation and thereby improve symptoms but do not necessarily increase survival.

    • This question is part of the following fields:

      • Respiratory
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  • Question 14 - A 64 year old woman with ankylosing spondylitis presents with cough, weight loss...

    Incorrect

    • A 64 year old woman with ankylosing spondylitis presents with cough, weight loss and tiredness. Her chest x-ray shows longstanding upper lobe fibrosis. Three sputum tests stain positive for acid fast bacilli (AFB) but are consistently negative for Mycobacterium tuberculosis on culture.
       
      Which of the following is the most likely causative agent?

      Your Answer:

      Correct Answer: Mycobacterium avium intracellular complex

      Explanation:

      Pulmonary mycobacterium avium complex (MAC) infection in immunocompetent hosts generally manifests as cough, sputum production, weight loss, fever, lethargy, and night sweats. The onset of symptoms is insidious.
      In patients who may have pulmonary infection with MAC, diagnostic testing includes acid-fast bacillus (AFB) staining and culture of sputum specimens.

      The ATS/IDSA guidelines include clinical, radiographic, and bacteriologic criteria to establish a diagnosis of nontuberculous mycobacterial lung disease.

      Clinical criteria are as follows:

      Pulmonary signs and symptoms such as cough, fatigue, weight loss; less commonly, fever and weight loss; dyspnoea

      Appropriate exclusion of other diseases (e.g., carcinoma, tuberculosis).

      At least 3 sputum specimens, preferably early-morning samples taken on different days, should be collected for AFB staining and culture. Sputum AFB stains are positive for MAC in most patients with pulmonary MAC infection. Mycobacterial cultures grow MAC in about 1-2 weeks, depending on the culture technique and bacterial burden.

    • This question is part of the following fields:

      • Respiratory
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  • Question 15 - A 28-year-old woman presents with intermittent episodes of diarrhoea, constipation, abdominal bloating and...

    Incorrect

    • A 28-year-old woman presents with intermittent episodes of diarrhoea, constipation, abdominal bloating and flatulence. Clinical examination is unremarkable. Faecal occult bloods are negative and haematological and biochemical investigations are unremarkable.

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

      Your Answer:

      Correct Answer: Trial of dairy-free diet

      Explanation:

      The best next step is to try a dairy-free diet, many patients may develop this in their lifetime. IBS is a diagnosis of exclusion, and one would need to rule lactose intolerance out as a potential aetiology first. She is only 28, and without overt bleeding or signs/sxs/labs suggestive of obstruction or inflammation; colonoscopy, flex sig and a barium enema are not indicated.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 16 - A 54 yr. old heavy smoker presented with acute chest pain for 3...

    Incorrect

    • A 54 yr. old heavy smoker presented with acute chest pain for 3 hrs which associated with excessive sweating and vomiting. His past medical history was unremarkable but his father has passed away due to a heart attack at the age of 50. Examination findings were normal and ECG was also normal. He was pain free after 12 hours from admission. What is the most appropriate investigation that cab be done at this moment?

      Your Answer:

      Correct Answer: Troponin T

      Explanation:

      The positive family history and the smoking make him an ideal candidate for a myocardial infarction. The chest pain is also a suggestive symptom. So troponin is needed to rule out MI.

    • This question is part of the following fields:

      • Cardiology
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  • Question 17 - A 24-year-old waiter applies for a job at a cafeteria. He gives a...

    Incorrect

    • A 24-year-old waiter applies for a job at a cafeteria. He gives a history of having had enteric fever 2 years ago. Which of the following investigations is most likely to indicate a chronic carrier status?

      Your Answer:

      Correct Answer: Culture of intestinal secretions

      Explanation:

      The chronic asymptomatic carrier state is thought to be why there is continued appearance of the bacterium in human populations. As shedding of the organism is intermittent and sometimes at low levels, methods to detect it have been limited. The Salmonella typhi may be cultured from intestinal secretions, faeces or urine in chronic carriers and is recommended to confirm the diagnosis. Vi agglutination test can also be high in normal people in areas with typhoid endemic. Full blood count or blood culture would not be helpful to determine carrier status. Widal antigen test is unable to differentiate carriers from people with a hx of prior infection.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 18 - 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 19 - A 65 yr. male patient was started on warfarin for chronic atrial fibrillation...

    Incorrect

    • A 65 yr. male patient was started on warfarin for chronic atrial fibrillation (AF). Which of the following clotting factors is not affected by warfarin?

      Your Answer:

      Correct Answer: Factor XII

      Explanation:

      Carboxylation of factor II, VII, IX, X and protein C is affected by warfarin. Factor XII is not affected.

    • This question is part of the following fields:

      • Cardiology
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  • Question 20 - A 32 year old primigravida, with a history of pulmonary hypertension, presents to...

    Incorrect

    • A 32 year old primigravida, with a history of pulmonary hypertension, presents to the clinic at 36 weeks gestation with worsening shortness of breath.
      Which of the following is the most accurate statements regarding her condition?

      Your Answer:

      Correct Answer: Risk of maternal mortality in patients with pulmonary hypertension is 30%

      Explanation:

      Historically, high rates of maternal and fetal death have been reported for pregnant women with pulmonary hypertension (30–56% and 11–28%, respectively). The causes of poor maternal outcomes are varied and include risk of death from right heart failure and stroke from intracardiac shunting. Furthermore, there is a high peri-/post-partum risk due to haemodynamic stress, bleeding complications and the use of general anaesthesia, which can all lead to right heart failure.
      The most common risk to the foetus is death, with premature birth and growth retardation being reported in successfully delivered children.
      CXR is not contraindicated in pregnancy. D-dimers are not used as a diagnostic aid as they are almost always elevated in pregnancy. Nifedipine, although contraindicated in pregnant women may be used judiciously if the need arises.

    • This question is part of the following fields:

      • Respiratory
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  • Question 21 - A 65 yr. old male with a history of smoking and alcohol was...

    Incorrect

    • A 65 yr. old male with a history of smoking and alcohol was admitted with an ST elevation myocardial infarction. He was obese and lives a sedentary lifestyle. What is the non-pharmacological intervention which will be most helpful to reduce future ischaemic events?

      Your Answer:

      Correct Answer: Stopping smoking

      Explanation:

      Stopping smoking is the single most effective non-pharmacological intervention which will reduce future ischaemic events. But the rest of the responses are also important interventions with regards to reducing future ischaemic events.

    • This question is part of the following fields:

      • Cardiology
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  • Question 22 - A 23-year-old woman presents to the A&E with a 24-hour-history of gradual-onset fever,...

    Incorrect

    • A 23-year-old woman presents to the A&E with a 24-hour-history of gradual-onset fever, light sensitivity and headache. Clinical examination reveals neck stiffness and an area of rash which does not disappear upon pressure on her right shin. Anamnesis reveals a history of 3 episodes of meningococcal meningitis in the past and she was started on ceftriaxone for another suspected meningitis. However, you suspect that the patients might be immunodeficient. Which immunodeficiency does she most probably have?

      Your Answer:

      Correct Answer: C5-9 deficiency

      Explanation:

      Pneumococcal meningitis is the most common and severe form of bacterial meningitis. Fatality rates are substantial, and long-term sequelae develop in about half of survivors. Disease outcome has been related to the severity of the proinflammatory response in the subarachnoid space. The complement system, which mediates key inflammatory processes, has been implicated as a modulator of pneumococcal meningitis disease severity in animal studies. C5 fragment levels in cerebrospinal fluid (CSF) of patients with bacterial meningitis correlated with several clinical indicators of poor prognosis. The common terminal pathway consists of complement components C5–C9, and activation forms the anaphylatoxin C5a, a strong proinflammatory mediator, and the membrane attack complex (MAC), which creates pores in the bacterial cell wall (12). Deficiencies in these late complement components have been recognized as a cause of recurrent and familial meningococcal infections.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 23 - Which of the following statements is true concerning gastrin? ...

    Incorrect

    • Which of the following statements is true concerning gastrin?

      Your Answer:

      Correct Answer: Release is triggered by GI luminal peptides

      Explanation:

      Gastrin is released by G cells in the antrum of the stomach. It stimulates secretion of gastric acid (HCl) by the parietal cells of the stomach and also aids in gastric motility. It is released in response to the following stimuli: vagal stimulation, antrum distention, hypercalcemia. It is inhibited by the following: presence of acid in stomach, SST, secretion, GIP, VIP, glucagon, calcitonin.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 24 - A 45-year-old woman with a history of hypothyroidism, presents with ptosis and muscle...

    Incorrect

    • A 45-year-old woman with a history of hypothyroidism, presents with ptosis and muscle weakness. She's noticed that her muscle weakness becomes worse towards the end of the day. Clinical examination reveals fatigable ptosis and proximal limb weakness. Myasthenia gravis is suspected. Which receptor is implicated in the pathophysiology of this condition?

      Your Answer:

      Correct Answer: Nicotinic acetylcholine receptors

      Explanation:

      Myasthenia gravis (MG) is an organ-specific autoimmune disease caused by an antibody-mediated assault on the muscle nicotinic acetylcholine receptor (AChR) at the neuromuscular junction. Binding of antibodies to the AChR leads to loss of functional AChRs and impairs the neuromuscular signal transmission, resulting in muscular weakness.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 25 - A cohort study is developed to assess the correlation between blood pressure and...

    Incorrect

    • A cohort study is developed to assess the correlation between blood pressure and working long hours. After 10 years of follow-up and for the 1050 individuals working less than 40 hours per week, 1000 patients had normal blood pressure and 50 patients were diagnosed with hypertension. For the 660 patients working more than 40 hours per week, 600 patients had normal blood pressure and 60 patients were diagnosed with hypertension. If you work more than 40 hours per week, what is the odds ratio of developing hypertension compared to the individuals working less than 40 hours per week?

      Your Answer:

      Correct Answer: 2

      Explanation:

      An odds ratio (OR) is a measure of the association between an exposure and an outcome. The OR represents the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure. Odds ratios are most commonly used in case-control studies, however they can also be used in cross-sectional and cohort study designs as well (with some modifications and/or assumptions). Where

      a = Number of exposed cases

      b = Number of exposed non-cases

      c = Number of unexposed cases

      d = Number of unexposed non-cases

      OR=(a/c) / (b/d) = ad/bc

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 26 - A 40-year-old man presents with a history of carpal tunnel syndrome and osteoarthritis...

    Incorrect

    • A 40-year-old man presents with a history of carpal tunnel syndrome and osteoarthritis of his weight-bearing joints. He has recently begun to suffer from symptoms of sleep apnoea.
      On examination, he has a prominent jawline and macroglossia. His BP is elevated at 155/95 mmHg and there is peripheral visual field loss.
      Which of the following is true?

      Your Answer:

      Correct Answer: Pegvisomant can be used where IGF-1 is not normalised post surgery

      Explanation:

      The patient has Acromegaly.
      Acromegaly is a chronic disorder characterised by growth hormone (GH) hypersecretion, predominantly caused by a pituitary adenoma.

      Random GH level testing is not recommended for diagnosis given the pulsatile nature of secretion. Stress, physical exercise, acute critical illness and fasting state can cause a physiological higher peak in GH secretion.

      Pegvisomant is a US Food and Drug Administration-approved treatment for use after surgery. In a global non-interventional safety surveillance study, pegvisomant normalised IGF-1 in 67.5% of patients after 5 years (most likely due to lack of dose-up titration), and also improved clinical symptoms. Pegvisomant improves insulin sensitivity, and long-term follow-up showed significantly decreased fasting glucose over time, while the first-generation SRL only have a marginal clinical impact on glucose homeostasis in acromegaly. Pegvisomant does not have any direct anti-proliferative effects on pituitary tumour cells, but tumour growth is rare overall.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 27 - A 22-year-old woman has ingested an unknown quantity of paracetamol tablets four hours...

    Incorrect

    • A 22-year-old woman has ingested an unknown quantity of paracetamol tablets four hours ago. She now presents with nausea, vomiting, anorexia and right subchondral pain.

      Which of the following features suggest that she should be transferred to the liver unit?

      Your Answer:

      Correct Answer: pH 7.25

      Explanation:

      The most widely used prognostic predictors for acetaminophen over-ingestion is King’s College Criteria, which is: arterial PH < 7.3 after fluid resuscitation, Cr level > 3.4, PT > 1.8x control or > 100s, or INR > 6.5, and Grave III or IV encephalopathy.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 28 - A 2-day-old girl is admitted by her mother because she gets cyanotic upon...

    Incorrect

    • A 2-day-old girl is admitted by her mother because she gets cyanotic upon feeding and she wouldn't stop crying. The doctors suspect a congenital heart disease. What is the most probable aetiology?

      Your Answer:

      Correct Answer: Transposition of the great arteries

      Explanation:

      Transposition of the great arteries results in a significant hypoxemic status that is observed clinically by central cyanosis. The bluish discoloration of the skin and mucous membranes is therefore the basic pattern of clinical presentation in transposition. Its onset and severity depend on anatomical and functional variants that influence the degree of mixing between the two circulations. Limited intercirculatory mixing, usually present if the ventricular septum is intact or the atrial septal defect is restrictive, is related to progressive and profound central cyanosis evident within the first hours of life. Tachypnoea, tachycardia, diaphoresis, poor weight gain, a gallop rhythm, and eventually hepatomegaly can be then detected later on during infancy. Heart murmurs associated with left outflow tract obstruction, due to a persistent arterial duct or a septal defect may be heard, but they are not a constant finding.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 29 - A female in her early 20's who has been diagnosed with asthma for...

    Incorrect

    • A female in her early 20's who has been diagnosed with asthma for the past four years visits the office for a review. She has been using Beclomethasone dipropionate inhaler 200mcg bd along with Salbutamol inhaler 100mcg prn and her asthma is still uncontrolled. Her chest examination is clear and she has good inhaler technique. What would be the most appropriate next step in the management of her asthma?

      Your Answer:

      Correct Answer: Add a leukotriene receptor antagonist

      Explanation:

      The NICE 2017 guidelines state that in patients who are uncontrolled with a SABA (Salbutamol) and ICS (Inhaled corticosteroid e.g. Beclomethasone), a leukotriene receptor antagonist (LTRA) should be added.
      If asthma is uncontrolled in adults (aged 17 and over) on a low dose of ICS as maintenance therapy, offer a leukotriene receptor antagonist (LTRA) in addition to the ICS and review the response to treatment in 4 to 8 weeks.

      This recommendation is also stated in NICE 2019 guidelines.

    • This question is part of the following fields:

      • Respiratory
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  • Question 30 - 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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