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  • Question 1 - A 33-year-old lady who is known hepatitis C positive comes to your clinic....

    Incorrect

    • A 33-year-old lady who is known hepatitis C positive comes to your clinic. She is 28 weeks pregnant and her obstetrician wants you to assess her and provide medical advice for the mother and child.

      Which of the following statements concerning hepatitis C are most accurate in her case?

      Your Answer: Mother to baby transmission of hepatitis C is 15%

      Correct Answer: Breast-feeding does not increase the risk of transmission

      Explanation:

      Breast feeding has not been shown to increase the risk of transmission of HCV from mother to baby. This is simply a fact to memorize. The other answer choices are not the most accurate as there is no evidence-proven way to decrease the chance that baby will get HCV from the mother during the birth. About 5 out of every 100 infants born to HCV infected mothers become infected.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 2 - A 70-year-old female presented to her ophthalmologist with a complaint of weakening eyesight...

    Incorrect

    • A 70-year-old female presented to her ophthalmologist with a complaint of weakening eyesight despite continued use of her corrective glasses. She also had a history of mild headaches for a few weeks. On fundoscopy, the disc had blurred margins with mild cupping and a sickle shaped scotoma in both eyes. What is the most appropriate treatment in this case?

      Your Answer:

      Correct Answer: Pilocarpine eye drops

      Explanation:

      Frequent change of eye glasses, scotoma, and mild cupping are suggestive of primary open angle glaucoma. This means that the anterior angle of the eye is normal but there is a problem in the trabecular meshwork, where the Schlemm’s Canal is not allowing the drainage of the aqueous humor. Pilocarpine should be given to the patient because it is a parasympathomimetic agent. It causes the ciliary muscle of the eye to contract, causing the trabecular meshwork to open up, allowing the aqueous humor to drain again.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 3 - A young man presents to the clinic with recurrent episodes of breathlessness. Past...

    Incorrect

    • A young man presents to the clinic with recurrent episodes of breathlessness. Past medical history reveals recurrent episodes of colicky abdominal pain for the past three years.

      On examination, he has a productive cough with foul smelling sputum.

      Investigations show: Sputum culture with Heavy growth of Pseudomonas aeruginosa and Haemophilus influenzae.
      Chest x-ray: Tramline and ring shadows.

      What is his diagnosis?

      Your Answer:

      Correct Answer: Cystic fibrosis

      Explanation:

      Cystic fibrosis (CF) is a multisystemic, autosomal recessive disorder that predominantly affects infants, children, and young adults. CF is the most common life-limiting genetic disorder in whites, with an incidence of 1 case per 3200-3300 new-borns in the United States.

      People with CF can have a variety of symptoms, including:
      Very salty-tasting skin
      Persistent coughing, at times with phlegm
      Frequent lung infections including pneumonia or bronchitis
      Wheezing or shortness of breath
      Poor growth or weight gain in spite of a good appetite
      Frequent greasy, bulky stools or difficulty with bowel movements
      Male infertility

      Signs of bronchiectasis include the tubular shadows; tram tracks, or horizontally oriented bronchi; and the signet-ring sign, which is a vertically oriented bronchus with a luminal airway diameter that is 1.5 times the diameter of the adjacent pulmonary arterial branch.

      Bronchiectasis is characterized by parallel, thick, line markings radiating from hila (line tracks) in cylindrical bronchiectasis. Ring shadows represent dilated thick-wall bronchi seen in longitudinal section or on-end or dilated bronchi in varicose bronchiectasis.

      Pseudomonas aeruginosa is the key bacterial agent of cystic fibrosis (CF) lung infections, and the most important pathogen in progressive and severe CF lung disease. This opportunistic pathogen can grow and proliferate in patients, and exposure can occur in hospitals and other healthcare settings.

      Haemophilus influenzae is regularly involved in chronic lung infections and acute exacerbations of CF patients

    • This question is part of the following fields:

      • Respiratory
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  • Question 4 - A 62-year-old laboratory technician presents to the ophthalmology emergency department with sudden onset...

    Incorrect

    • A 62-year-old laboratory technician presents to the ophthalmology emergency department with sudden onset painless loss of vision in the right eye. He describes it as having a dense shadow over his vision, progressing from the periphery to the centre. He has no past medical history of note.

      Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Retinal detachment

      Explanation:

      The most common causes of a sudden painless loss of vision are as follows:
      – Ischaemic optic neuropathy (e.g. temporal arteritis or atherosclerosis)
      – Occlusion of central retinal vein
      – Occlusion of central retinal artery
      – Vitreous haemorrhage
      – Retinal detachment

      Retinal detachment is a cause of sudden painless loss of vision. It is characterised by a dense shadow starting peripherally and progressing centrally.

      Vitreous haemorrhage usually presents with dark spots.

      Central retinal artery and central retinal vein occlusion do not usually present with progressing dense shadow.

      This man’s lack of ischaemic risk factors makes ischaemic optic neuropathy less likely.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 5 - A 19-year-old lady with established anorexia nervosa is admitted with a BMI of...

    Incorrect

    • A 19-year-old lady with established anorexia nervosa is admitted with a BMI of 16. However, she gives the consent to be fed by a nasogastric tube. Which of the following electrolyte disturbances are you most likely to find?

      Your Answer:

      Correct Answer: Hypophosphataemia

      Explanation:

      Refeeding syndrome can be defined as the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally). These shifts result from hormonal and metabolic changes and may cause serious clinical complications. The hallmark biochemical feature of refeeding syndrome is hypophosphatemia. However, the syndrome is complex and may also feature abnormal sodium and fluid balance; changes in glucose, protein, and fat metabolism; thiamine deficiency; hypokalaemia; and hypomagnesaemia.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 6 - A 50-year-old male was brought to the ER after the accidental consumption of...

    Incorrect

    • A 50-year-old male was brought to the ER after the accidental consumption of 300 ml of diethylene glycol. Blood investigations were suggestive of metabolic acidosis and renal failure. What is the appropriate management in this patient?

      Your Answer:

      Correct Answer: Haemodialysis and oral ethanol

      Explanation:

      Among the given options the most appropriate management in this patient would be ethanol and haemodialysis.

      Ethanol competes with ethylene glycol for alcohol dehydrogenase and thus, helps manage a patient with ethylene glycol toxicity.

      Ethylene glycol is a type of alcohol used as a coolant or antifreeze
      Features of toxicity are divided into 3 stages:
      Stage 1: (30 min to 12 hours after exposure) Symptoms similar to alcohol intoxication: confusion, slurred speech, dizziness (CNS depression)
      Stage 2: (12 – 48 hours after exposure) Metabolic acidosis with a high anion gap and high osmolar gap. Also tachycardia, hypertension
      Stage 3: (24 – 72 hours after exposure) Acute renal failure

      Management has changed in recent times:
      Fomepizole, an inhibitor of alcohol dehydrogenase, is now used first-line in preference to ethanol.
      Ethanol has been used for many years works by competing with ethylene glycol for the enzyme alcohol dehydrogenase this limits the formation of toxic metabolites (e.g. glycolaldehyde and glycolic acid) which are responsible for the hemodynamic/metabolic features of poisoning.
      Haemodialysis has a role in refractory cases.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 7 - Which of the following is the mechanism of action of bivalirudin in acute...

    Incorrect

    • Which of the following is the mechanism of action of bivalirudin in acute coronary syndrome?

      Your Answer:

      Correct Answer: Reversible direct thrombin inhibitor

      Explanation:

      Bivalirudin is a competitive, direct thrombin inhibitor. It inhibits both free and clot-bound thrombin and thrombin-induced platelet aggregation. Thrombin enables fibrinogen conversion to fibrin during the coagulation cascade. So inhibition of fibrinogen conversion to fibrin inhibits thrombus development.

    • This question is part of the following fields:

      • Cardiology
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  • Question 8 - 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 9 - Drug-induced lupus erythematosus most often occurs after taking which of the following drugs?...

    Incorrect

    • Drug-induced lupus erythematosus most often occurs after taking which of the following drugs?

      Your Answer:

      Correct Answer: Procainamide

      Explanation:

      Many drugs are responsible for causing drug induced lupus. However, it is most commonly associated with hydralazine, procainamide and quinidine.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 10 - A 21 year old patient presents with multiple itchy wheals on his skin....

    Incorrect

    • A 21 year old patient presents with multiple itchy wheals on his skin. The wheals are of all sizes and they are exacerbated by scratching. The symptoms started after a viral infection and can last up to an hour. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Urticaria

      Explanation:

      Urticaria is a group of disorders that share a distinct skin reaction pattern, namely the occurrence of itchy wheals anywhere on the skin. Wheals are short-lived elevated erythematous lesions ranging from a few millimetres to several centimetres in diameter and can become confluent. The itching can be prickling or burning and is usually worse in the evening or night time. Triggering of urticaria by infections has been discussed for many years but the exact role and pathogenesis of mast cell activation by infectious processes is unclear.

    • This question is part of the following fields:

      • Dermatology
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  • Question 11 - A 11-year-old is referred to neurology due to episodes her GP feels are...

    Incorrect

    • A 11-year-old is referred to neurology due to episodes her GP feels are epileptiform. Her mother reports that she appears to just 'stop', sometimes even in mid conversation, for several seconds at random times during the day. During these episodes, she can be unresponsive to questioning and has no recollection of them.

      Which of these drugs is contraindicated in this condition?

      Your Answer:

      Correct Answer: Carbamazepine

      Explanation:

      The patient’s history points to absence seizures. Carbamazepine has been shown to aggravate generalized seizure types, especially absence seizures, because it acts directly on the ventrobasal complex of the thalamus which is critical to the neurophysiology of absence seizures.

    • This question is part of the following fields:

      • Neurology
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  • Question 12 - A 56-year-old male presents to the emergency department with confusion and agitation for...

    Incorrect

    • A 56-year-old male presents to the emergency department with confusion and agitation for the past four hours. He is a known alcoholic who has abstained from drinking for the past three days.
      On examination, he is sweating, agitated and disorientated. His temperature is 37.7°C, pulse 112 bpm regular and blood pressure is 150/76 mmHg.
      Blood investigations performed in the emergency department reveal:
      FBC: Normal
      U&E: Normal
      Plasma glucose: 4.6 mmol/l (3.6-6)
      Which of the following medications would be the most appropriate treatment for this man?

      Your Answer:

      Correct Answer: Oral lorazepam

      Explanation:

      The most probable diagnosis for this patient is delirium tremens due to alcohol withdrawal, which should be treated as a medical emergency. 
      Delirium tremens is a hyperadrenergic state and is often associated with tachycardia, hyperthermia, hypertension, tachypnoea, tremor, and mydriasis.
      Treatment:
      – The most common and validated treatment for alcohol withdrawal is benzodiazepine: first-line treatment includes oral lorazepam.
      – If the symptoms persist, or the medication is refused, parenteral lorazepam, haloperidol or olanzapine should be given.
      – Central-acting, alpha-2 agonists such as clonidine and dexmedetomidine should not be used alone for the treatment of alcohol withdrawal.
      – It is also recommended to avoid using alcohol, antipsychotics, anticonvulsants, beta-adrenergic receptor blockers, and baclofen for the treatment of alcohol withdrawal as there are not enough studies to support the safety of these.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 13 - A 25-year-old woman presented to the ED with carbon monoxide poisoning. High-flow oxygen...

    Incorrect

    • A 25-year-old woman presented to the ED with carbon monoxide poisoning. High-flow oxygen was administered immediately. She had a GCS of 15 and her vitals were stable. Which one of the following is not an indication for hyperbaric oxygen therapy in this scenario?

      Your Answer:

      Correct Answer: A carboxyhaemoglobin concentration of 16%

      Explanation:

      Carbon monoxide (CO) poisoning, considered as the great imitator of other diseases, as the patients present with a myriad of symptoms. The carbon monoxide diffuses rapidly across the pulmonary capillary membrane binding to the haem molecule with a very high affinity (240 times that of oxygen) forming carboxy-haemoglobin (COHb). Non-smokers have a baseline COHb of ,3% while smokers have a baseline COHb of 10-15%.

      Use of Hyperbaric oxygen therapy (HBOT) for treatment of mild to moderate CO poisoning is not routine.
      The selection criteria for HBOT in cases of CO poisoning include:
      • COHb levels > 20-25%
      • COHb levels > 20% in pregnant patient
      • Loss of consciousness
      • Severe metabolic acidosis (pH <7.1)
      • Evidence of end-organ ischemia (e.g., ECG changes, chest pain, or altered mental status)
      Principle of HBOT:
      Exposing patients to 100 percent oxygen under supra-atmospheric conditions results in a decrease in the half-life (t1/2) of COHb, from , 90 min in atmospheric air to , 30 minutes. The amount of oxygen dissolved in the blood also rises from , 0.3 to 6 mL/dL, increasing the delivery of non-haemoglobin-bound oxygen to the tissues.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 14 - A 43-year-old man is about to be started on chemotherapy for a high-grade...

    Incorrect

    • A 43-year-old man is about to be started on chemotherapy for a high-grade lymphoma. He is given intravenous rasburicase to help lower the risk of tumour lysis syndrome (TLS).

      What is the mechanism of action of this drug?

      Your Answer:

      Correct Answer: Converts uric acid to allantoin

      Explanation:

      Rasburicase is a recombinant version of urate oxidase which is an enzyme that metabolizes uric acid to allantoin.

      TLS is a potentially fatal condition occurring as a complication during the treatment of high-grade lymphomas and leukaemias. It occurs from the simultaneous breakdown (lysis) of the tumour cells and subsequent release of chemicals into the bloodstream. This leads to hyperkalaemia and hyperphosphatemia in the presence of hyponatraemia. TLS can occur in the absence of chemotherapy, but it is usually triggered by the introduction of combination chemotherapy. Awareness of the condition is critical for its prophylactic management.

      Patients at high risk of TLS should be given IV rasburicase or IV allopurinol immediately prior to and during the first few days of chemotherapy. Allantoin is much more water soluble than uric acid and is therefore more easily excreted by the kidneys. Patients in lower-risk groups should be given oral allopurinol during cycles of chemotherapy in an attempt to avoid the condition.

      TLS is graded according to the Cairo-Bishop scoring system as:
      1. Laboratory tumour lysis syndrome
      2. Clinical tumour lysis syndrome

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 15 - A 72-year-old woman who presented with headache and neck stiffness was started on...

    Incorrect

    • A 72-year-old woman who presented with headache and neck stiffness was started on IV ceftriaxone after undergoing a lumber puncture. The CSF culture shows listeria monocytogenes. What is the treatment of choice?

      Your Answer:

      Correct Answer: Change to IV amoxicillin + gentamicin

      Explanation:

      The best option would be the combination of ampicillin and gentamycin. Changing to IV amoxicillin+gentamycin is however the best among the given choices here.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 16 - A 60-year-old gentleman presents with symptoms of nocturia and difficulty in passing urine....

    Incorrect

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

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

      Your Answer:

      Correct Answer: Finasteride

      Explanation:

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

    • This question is part of the following fields:

      • Nephrology
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  • Question 17 - Which of the following options best describes rheumatoid factor? ...

    Incorrect

    • Which of the following options best describes rheumatoid factor?

      Your Answer:

      Correct Answer: IgM against the Fc portion of IgG

      Explanation:

      Rheumatoid factor is an IgM antibody that targets the Fc portion of IgG.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 18 - A 60–year-old woman comes to the hospital for chemotherapy for breast cancer.
    On...

    Incorrect

    • A 60–year-old woman comes to the hospital for chemotherapy for breast cancer.
      On examination, her pulse is 120 bpm and regular and BP is 90/60. Her JVP is not seen, her heart sounds are normal, and her chest is clear. There is evidence of a right mastectomy. Abdominal and neurological examination is normal.
      Short synacthen test was ordered and the results came as follows:
      Time (min):
      0,
      30,
      60.
      Cortisol (nmol/l):
      90,
      130,
      145.

      Which two of the following would be your immediate management?

      Your Answer:

      Correct Answer: Intravenous normal saline six-hourly

      Explanation:

      Synacthen test interpretation:
      – Basal Cortisol level should be greater than 180nmol/L
      – 30min or 60min Cortisol should be greater than 420nmol/L (whatever the basal level)
      – The increment should be at least 170nmol/L, apart from in severely ill patients where adrenal output is already maximal.
      The patient’s results show that she has Acute Adrenal Insufficiency
      The guidelines include the following recommendations for emergency treatment:
      Administer hydrocortisone: Immediate bolus injection of 100 mg hydrocortisone intravenously or intramuscularly followed by continuous intravenous infusion of 200 mg hydrocortisone per 24 hours (alternatively, 50 mg hydrocortisone per intravenous or intramuscular injection every 6 h)
      Rehydrate with rapid intravenous infusion of 1000 mL of isotonic saline infusion within the first hour, followed by further intravenous rehydration as required (usually 4-6 L in 24 h; monitor for fluid overload in case of renal impairment and elderly patients)
      Contact an endocrinologist for urgent review of the patient, advice on further tapering of hydrocortisone, and investigation of the underlying cause of the disease, including the diagnosis of primary versus secondary adrenal insufficiency
      Tapering of hydrocortisone can be started after clinical recovery guided by an endocrinologist; in patients with primary adrenal insufficiency, mineralocorticoid replacement must be initiated (starting dose 100 μg fludrocortisone once daily) as soon as the daily glucocorticoid dose is below 50 mg of hydrocortisone every 24 hours

    • This question is part of the following fields:

      • Endocrinology
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  • Question 19 - A 32 yr. old male who was on methadone has suddenly collapsed while...

    Incorrect

    • A 32 yr. old male who was on methadone has suddenly collapsed while running and was found dead. What is the most likely cause for his death?

      Your Answer:

      Correct Answer: Prolonged QT

      Explanation:

      Methadone and cocaine can cause QT prolongation through the direct effects on the resting membrane potential. Methadone can increase QT dispersion in addition to QT interval. Methadone inhibits the Human Ether-a-go-go Related Gene (hERG) and causes QTc prolongation and development of Torsades de point. Brugada-like syndrome is another condition found in methadone users which predisposes the users to life-threatening ventricular tachycardia and sudden cardiac death.

    • This question is part of the following fields:

      • Cardiology
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  • Question 20 - Which of the following is most commonly associated with the development of pseudomembranous...

    Incorrect

    • Which of the following is most commonly associated with the development of pseudomembranous colitis?

      Your Answer:

      Correct Answer: Cefuroxime

      Explanation:

      Pseudomembranous colitis is caused by a C. difficile infection that causes membranes to form on the colon wall. It is caused most commonly by broad-spectrum antibiotics. This would include cephalosporins, broad-spectrum penicillin, and clindamycin. Macrolides and quinolones have also been reported as potential aetiologies, but much less commonly.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 21 - A 30-year-old female presents with a 4-day history of diarrhoea and vomiting. She...

    Incorrect

    • A 30-year-old female presents with a 4-day history of diarrhoea and vomiting. She has been unable to keep fluids down for 4 days and has been treated with metoclopramide. She develops a dystonic reaction.
      What is the most appropriate treatment for the woman?

      Your Answer:

      Correct Answer: Benztropine

      Explanation:

      Acute dystonic reactions (extrapyramidal symptoms) such as spasmodic torticollis, trismus, and oculogyric crises can occur following the administration of metoclopramide or stemetil and thus, neither is recommended for the treatment of nausea in young women.

      Such reactions respond well to treatment with benztropine or procyclidine.
      – Benztropine: It is an anticholinergic medication with significant CNS penetration.
      A single dose of benztropine 1 to 2 mg IV followed by 1 to 2 mg p.o twice a day for up to 7 days to prevent a recurrence. Subsequently, both the offending agent and those from the same group should be avoided.
      – Alternatively, diphenhydramine can be used intravenously (up to a dose of 50mg) or intramuscularly followed by p.o therapy every 6 hours for 1 to 2 to prevent a recurrence.
      – Second-line therapy with IV benzodiazepines is reserved for those patients who do not respond to anticholinergics.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 22 - An 18 year old boy from Middle East presented with a 1 month...

    Incorrect

    • An 18 year old boy from Middle East presented with a 1 month history of a yellowish, crusted plaque over his scalp, along with some scarring alopecia. What will the likely diagnosis be?

      Your Answer:

      Correct Answer: Favus

      Explanation:

      Favus is a fungal infection of the scalp, resulting in the formation of a yellowish crusted plaque over the scalp and leads to scar formation with alopecia. Tinea capitus is a fungal infection of the scalp resulting in scaling and non scarring hair loss. Folliculitis presents with multiple perifollicular papules which can be caused by both bacteria and fungi. Cradle cap usually affects infants where the whole scalp is involved. It can lead to hair loss and responds to topical antifungals and keratolytics.

    • This question is part of the following fields:

      • Dermatology
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  • Question 23 - A 65 year old gentleman presented with 4 months history of a non...

    Incorrect

    • A 65 year old gentleman presented with 4 months history of a non healing lesion over the right ear. It is about 1cm in size and bleeds when palpated. The most likely diagnosis will be?

      Your Answer:

      Correct Answer: Squamous cell carcinoma

      Explanation:

      Squamous cell carcinoma like other skin cancers mostly arise on photo exposed sites. A patient usually presents with a history of a non healing lesion or wound. Confirmatory diagnosis requires a skin biopsy and histopathological screening. It is rarely metastatic and treatment of choice is surgical excision.

    • This question is part of the following fields:

      • Dermatology
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  • Question 24 - A literature review of a number of studies was conducted to assess the...

    Incorrect

    • A literature review of a number of studies was conducted to assess the potential efficacy of a new drug, which may reduce the chance of patients with chronic kidney disease (CKD) developing gout. In one study 120 out of 1,200 patients receiving the new drug developed gout. The total number of the patients were 2,000 and the remaining 800 individuals received a placebo. From the patients that had received the placebo, 200 developed gout. What is the absolute risk reduction of developing gout?

      Your Answer:

      Correct Answer: 15%

      Explanation:

      Absolute risk reduction (ARR) – also called risk difference (RD) – is the most useful way of presenting research results to help your decision-making. Absolute risk reduction = (Control event rate) – (Experimental event rate) = 0.15 = 15%

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 25 - All of the following statements regarding glucagon-like peptide-1 (GLP-1) are true, except? ...

    Incorrect

    • All of the following statements regarding glucagon-like peptide-1 (GLP-1) are true, except?

      Your Answer:

      Correct Answer: Increased levels are seen in type 2 diabetes mellitus

      Explanation:

      Glucagon-like peptide 1 (GLP-1) is a 30-amino acid peptide hormone produced in the intestinal epithelial endocrine L-cells by differential processing of proglucagon. GLP-1 is released in response to meal intake.
      The main actions of GLP-1 are to stimulate insulin secretion (i.e., to act as an incretin hormone) and to inhibit glucagon secretion, thereby contributing to limit postprandial glucose excursions. It also inhibits gastrointestinal motility and secretion and thus acts as an enterogastrone and part of the ileal brake mechanism. GLP-1 also appears to be a physiological regulator of appetite and food intake.
      Decreased secretion of GLP-1 may contribute to the development of obesity, and exaggerated secretion may be responsible for postprandial reactive hypoglycaemia.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 26 - A 65-year-old woman presents at clinic complaining of worsening hoarseness of voice and...

    Incorrect

    • A 65-year-old woman presents at clinic complaining of worsening hoarseness of voice and dyspnoea over the past month. She has a history of toxic multinodular goitre successfully treated with radioiodine. On examination, she has a firm asymmetrical swelling of the thyroid gland. Laryngoscopy demonstrates a right vocal cord paralysis and apparent external compression of the trachea.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Anaplastic thyroid cancer

      Explanation:

      Thyroid malignancies are divided into papillary carcinomas (80%), follicular carcinomas (10%), medullary thyroid carcinomas (5-10%), anaplastic carcinomas (1-2%), primary thyroid lymphomas (rare), and primary thyroid sarcomas (rare).
      Hürthle cell carcinoma is a rare thyroid malignancy that is often considered a variant of follicular carcinoma.
      – Papillary and Follicular carcinoma are slow-growing tumours
      – Sporadic cases of Medullary thyroid carcinoma also typically manifest with painless solitary thyroid nodules in the early stages.
      – Anaplastic thyroid carcinoma has the most aggressive biologic behaviour of all thyroid malignancies and has one of the worst survival rates of all malignancies in general. It manifests as a rapidly growing thyroid mass in contrast to a well-differentiated carcinoma, which are comparatively slow-growing. Patients commonly present with associated symptoms due to local invasion. Hoarseness and dyspnoea resulting from the involvement of the recurrent laryngeal nerve and airway occur in as many as 50% of patients.
      – Almost all patients with primary thyroid lymphoma have either a clinical history or histological evidence of chronic lymphocytic thyroiditis. The risk of primary thyroid lymphoma increases 70-fold in patients with chronic lymphocytic thyroiditis compared with the general population. Regional and distant lymphadenopathy is common.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 27 - A 55-year-old alcoholic is admitted with portal hypertension. The wedged hepatic venous pressure...

    Incorrect

    • A 55-year-old alcoholic is admitted with portal hypertension. The wedged hepatic venous pressure is recorded. This pressure is reflective of which part of the hepatic vascular system?

      Your Answer:

      Correct Answer: Sinusoids

      Explanation:

      The wedged hepatic venous pressure is a reflection of the portal venous pressure in the hepatic sinusoids. This is a fact to remember. Here is a great but concise explanation as to why: https://www.ncbi.nlm.nih.gov/pubmed/18695309

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 28 - A 63 year old man with known allergic bronchopulmonary aspergillosis presents to the...

    Incorrect

    • A 63 year old man with known allergic bronchopulmonary aspergillosis presents to the A&E Department with an exacerbation. Which therapy represents the most appropriate management?

      Your Answer:

      Correct Answer: Oral glucocorticoids

      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.

      Treatment of ABPA aims to control inflammation and prevent further injury to your lungs. ABPA is a hypersensitivity reaction that requires treatment with oral corticosteroids. Inhaled steroids are not effective. ABPA is usually treated with a combination of oral corticosteroids and anti-fungal medications. The corticosteroid is used to treat inflammation and blocks the allergic reaction. Examples
      of corticosteroids include: prednisone, prednisolone or methylprednisolone. Inhaled corticosteroids alone – such as used for asthma treatment – are not effective in treating ABPA. Usually treatment with an oral corticosteroid is needed for months.

      The second type of therapy used is an anti-fungal medication, like itraconazole and voriconazole. These medicines help kill Aspergillus so that it no longer colonizes the airway. Usually one of these drugs is given for at least 3 to 6 months. However, even this treatment is not curative and can have side effects.

    • This question is part of the following fields:

      • Respiratory
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  • Question 29 - A 26-year-old man with type-1 diabetes presents for review. His HbA1c is 6.8%...

    Incorrect

    • A 26-year-old man with type-1 diabetes presents for review. His HbA1c is 6.8% yet he is concerned that his morning blood sugar levels are occasionally as high as 24 mmol/l. He is currently managed on a bd mixed insulin regime.
      He was sent for continuous glucose monitoring and his glucose profile reveals dangerous dipping in blood glucose levels during the early hours of the morning.
      Which of the following changes to his insulin regime is most appropriate?

      Your Answer:

      Correct Answer: Move him to a basal bolus regime

      Explanation:

      The patients high morning blood sugar levels are suggestive to Somogyi Phenomenon which suggests that hypoglycaemia during the late evening induced by insulin could cause a counter regulatory hormone response that produces hyperglycaemia in the early morning.
      Substitution of regular insulin with an immediate-acting insulin analogue, such as Humulin lispro, may be of some help.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 30 - A 27-year-old woman presents with recurrent headaches and sweating. On examination, a nodule...

    Incorrect

    • A 27-year-old woman presents with recurrent headaches and sweating. On examination, a nodule is felt in the region of the thyroid gland. She mentions that her mother had kidney stones and died following a tumour in her neck. A surgeon recommends complete thyroidectomy as her treatment of choice.

      What is the most important investigation to be done before the surgery?

      Your Answer:

      Correct Answer: 24-hour urinary catecholamines

      Explanation:

      The patient is most likely to have Medullary Thyroid Carcinoma (MTC).
      Sporadic, or isolated MTC accounts for 75% of cases and inherited MTC constitutes the rest.
      Inherited MTC occurs in association with multiple endocrine neoplasia (MEN) type 2A and 2B syndromes, but non-MEN familial MTC also occurs.
      A 24-hour urinalysis for catecholamine metabolites (e.g., vanillylmandelic acid [VMA], metanephrine) has to be done to rule out concomitant pheochromocytoma in patients with MEN type 2A or 2B, as Pheochromocytoma must be treated before MTC.

    • This question is part of the following fields:

      • Endocrinology
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