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  • Question 1 - Following a road traffic accident, a gentleman is brought to A&E. He is...

    Incorrect

    • Following a road traffic accident, a gentleman is brought to A&E. He is found to have oliguria and diagnosed with acute renal tubular necrosis.   What is the most common complication and cause of death in this condition?

      Your Answer: Congestive heart failure

      Correct Answer: Infection

      Explanation:

      In patients with acute renal tubular necrosis, infection in the form of gram-negative septicaemia is the most common cause of death, especially while the patient is awaiting spontaneous recovery of their renal function.

    • This question is part of the following fields:

      • Nephrology
      47.4
      Seconds
  • Question 2 - A 29-year-old male patient with a history of three previous chest infections in...

    Incorrect

    • A 29-year-old male patient with a history of three previous chest infections in the past seven months presents with fever, pleuritic pain and productive cough. Chest x-ray shows lobar consolidation and the diagnosis of a fourth chest infection is established, after sputum culture reveals Haemophilus influenzae. The previous chest infections were due to Streptococcus pneumoniae. After a period of six weeks, a full blood count, urea, CRP, electrolytes and chest x-ray turn out as normal. What is the investigation you would choose next?

      Your Answer: HIV test

      Correct Answer: Serum immunoglobulins

      Explanation:

      Hypogammaglobulinemia occurs due to a variety of underlying primary or secondary immunodeficient states, including HIV which is suspected in this case. The most commonly recognised clinical feature is recurrent infection.

    • This question is part of the following fields:

      • Clinical Sciences
      82.7
      Seconds
  • Question 3 - Which of the following is most consistent with congenital adrenal hyperplasia (CAH)? ...

    Incorrect

    • Which of the following is most consistent with congenital adrenal hyperplasia (CAH)?

      Your Answer: Delayed puberty

      Correct Answer: Premature epiphyseal closure

      Explanation:

      Exposure to excessive androgens is usually accompanied by premature epiphyseal maturation and closure, resulting in a final adult height that is typically significantly below that expected from parental heights.

      congenital adrenal hyperplasia (CAH) is associated with precocious puberty caused by long term exposure to androgens, which activate the hypothalamic-pituitary-gonadal axis. Similarly, CAH is associated with hyperpigmentation and hyperreninemia due to sodium loss and hypovolaemia.

    • This question is part of the following fields:

      • Endocrinology
      23.4
      Seconds
  • Question 4 - A new blood test developed to screen individuals for cardiac failure was performed...

    Incorrect

    • A new blood test developed to screen individuals for cardiac failure was performed on 500 patients. The results were positive for 40 out of 50 patients with echocardiography-established heart failure. However, the test was also positive for 20 patients with no signs of heart failure. What is the positive predictive value of the test?

      Your Answer: 0.8

      Correct Answer: 0.66

      Explanation:

      Positive predictive value = TP (true positives) / [TP + FP (false positives)] = 40 / (40 + 20) = 0.66

    • This question is part of the following fields:

      • Clinical Sciences
      32.9
      Seconds
  • Question 5 - A 30-year-old woman presents with amenorrhoea and galactorrhoea. She has normal visual fields....

    Incorrect

    • A 30-year-old woman presents with amenorrhoea and galactorrhoea. She has normal visual fields. You are concerned that she may have a prolactinoma. Investigations were done and the results are as shown below: Hb 12.5 g/dL, WCC 4.9 x109/L, PLT 199 x109/L, Na+ 140 mmol/L, K+ 4.9 mmol/L, Creatinine 90 ىmol/L, Prolactin 1150 mU/l. MRI shows a 7 mm pituitary microadenoma. Which of the following hormones would you expect to be lower than normal?

      Your Answer: Thyroxine

      Correct Answer: LH

      Explanation:

      Prolactinomas, benign lesions that produce the hormone prolactin, are the most common hormone-secreting pituitary tumours.
      Based on its size, a prolactinoma can be classified as a microprolactinoma (< 10 mm diameter) or a macroprolactinoma (>10 mm diameter). If the prolactinoma is large enough to compress the surrounding normal hormone-secreting pituitary cells, it may result in deficiencies of one or more hormones (e.g., thyroid-stimulating hormone [TSH], growth hormone [GH], adrenocorticotropic hormone). However, the patient has microadenoma so it is unlikely to cause compression manifestations.
      Hyperprolactinemia inhibits GnRH secretion from the medial basal hypothalamus and LH release from the pituitary.

    • This question is part of the following fields:

      • Endocrinology
      476.2
      Seconds
  • Question 6 - A 15-year-old girl is admitted to hospital following a ruptured ectopic pregnancy. She...

    Correct

    • A 15-year-old girl is admitted to hospital following a ruptured ectopic pregnancy. She comes from a family of Jehovah's Witnesses. Her haemoglobin on admission is 6.7 g/dl. She consents to a blood transfusion but her mother refuses. What is the most appropriate course of action?

      Your Answer: Give the blood transfusion

      Explanation:

      People aged 16 or over are entitled to consent to their own treatment. This can only be overruled in exceptional circumstances. Children under the age of 16 can consent to their own treatment if they’re believed to have enough intelligence, competence and understanding to fully appreciate what’s involved in their treatment. This is known as being Gillick competent.

      Otherwise, someone with parental responsibility can consent for them.
      This could be:
      the child’s mother or father
      the child’s legally appointed guardian
      a person with a residence order concerning the child
      a local authority designated to care for the child
      a local authority or person with an emergency protection order for the child.
      Giving the blood transfusion is therefore both clinically and ethically the right course of action.
      Jehovah’s Witnesses frequently carry a signed and witnessed Advance Decision Document listing the blood products and autologous procedures that are, or are not, acceptable to them It is appropriate to have a frank, confidential discussion with the patient about the potential risks of their decision and the possible alternatives to transfusion, but the freely expressed wish of a competent adult must always be respected.

    • This question is part of the following fields:

      • Clinical Sciences
      225
      Seconds
  • Question 7 - A 65-year-old man presents to you three weeks after initiating metformin for type...

    Incorrect

    • A 65-year-old man presents to you three weeks after initiating metformin for type 2 diabetes mellitus. His body mass index is 27.5 kg/m^2. At a dose of 500mg TDS the patient has experienced significant diarrhoea. Even on reducing the dose to 500mg BD his symptoms persisted. What is the most appropriate next step in this patient?

      Your Answer: Switch to gliclazide 40mg od

      Correct Answer: Start modified release metformin 500mg od with evening meal

      Explanation:

      Here, the patient seems to be intolerant to standard metformin. In such cases, modified-release preparations is considered as the most appropriate next step.
      There is some evidence that these produce fewer gastrointestinal side-effects in patients intolerant of standard-release metformin.

      Metformin is a biguanide and reduces blood glucose levels by decreasing the production of glucose in the liver, decreasing intestinal absorption and increasing insulin sensitivity.
      Metformin decreases both the basal and postprandial blood glucose.
      Other uses: In Polycystic Ovarian Syndrome (PCOS), Metformin decreases insulin levels, which then decreases luteinizing hormone and androgen levels. Thus acting to normalize the menstruation cycle.

      Note:
      Metformin is contraindicated in patients with severe renal dysfunction, which is defined as a glomerular filtration rate (GFR) less than 30 ml/min/1.732m2.
      Metformin overdose has been associated with hypoglycaemia and lactic acidosis, for this reason, it has a black box warning for lactic acidosis.

    • This question is part of the following fields:

      • Pharmacology
      50.1
      Seconds
  • Question 8 - A 26-year-old patient, previously fit and well, is admitted with fluctuating confusion and...

    Correct

    • A 26-year-old patient, previously fit and well, is admitted with fluctuating confusion and frank haematuria. He has recently been complaining of generalised malaise and joint pains. Examination reveals jaundice, splenomegaly, and petechiae. His blood pressure is 155/84 mmHg, temperature 37.9oC.   Initial investigations reveal: Haemoglobin 9.5 g/dL, White cell count 12 × 109/L, Platelets 40 × 109/L, Creatinine 142 μmol/L, Sodium 139 mmol/L, Potassium 4.5 mmol/L, Urea 9.2 mmol/L, Lactate dehydrogenase 495 U/l (10–250) Urinalysis Protein ++, blood +++ Blood film shows schistocytes   What treatment should NOT be given to this patient?

      Your Answer: Platelet transfusion

      Explanation:

      There is a strong suspicion of Thrombotic Thrombocytopenic Purpura (TTP) in this patient as he presents with neurological changes (from confusion to convulsions and coma), fever, haemolysis, thrombocytopenia, and renal failure. Additionally, TTP cases may present with jaundice, splenomegaly, and hypertension as seen in this patient. With a diagnosis of TTP, recent studies have shown that platelet transfusion is not recommended in this case because it has been shown to increase the risk for arterial thrombosis and mortality possibly due to increased aggregations.

    • This question is part of the following fields:

      • Nephrology
      88.5
      Seconds
  • Question 9 - A 32-year-old woman was referred for endoscopy and found to have a duodenal...

    Correct

    • A 32-year-old woman was referred for endoscopy and found to have a duodenal ulcer and a positive urease test. She was given lansoprazole, amoxicillin and clarithromycin for 7 days. Which of the following is the most appropriate way of determining the successful eradication of H. pylori?

      Your Answer: Urea breath test

      Explanation:

      Urea breath test is the most sensitive test to determine if there has been RESOLUTION/ERADICATION of the infection with H. pylori. The best test for initial diagnosis would be EGD with biopsy.

    • This question is part of the following fields:

      • Gastroenterology
      44.2
      Seconds
  • Question 10 - A 62-year-old female with a history of COPD and hypertension presents with pain...

    Correct

    • A 62-year-old female with a history of COPD and hypertension presents with pain on swallowing. Current medication includes a salbutamol and becotide inhaler, bendrofluazide and amlodipine. What is the most likely cause of the presentation?

      Your Answer: Oesophageal candidiasis

      Explanation:

      The history gives you a woman who is on inhaled steroid therapy. It is always a good idea for patients to rinse their mouths well after using inhaled steroids. Odynophagia (pain on swallowing) is a symptom of oesophageal candidiasis, which is the most likely answer given the steroids. Typically, you might see this in someone who is immunocompromised (classically, in HIV+ patients).

    • This question is part of the following fields:

      • Gastroenterology
      68.6
      Seconds
  • Question 11 - Which of the following is not a tumour suppressor gene? ...

    Incorrect

    • Which of the following is not a tumour suppressor gene?

      Your Answer: p53

      Correct Answer: myc

      Explanation:

      Myc is a family of regulator genes and proto-oncogenes that code for transcription factors.

      A tumor suppressor gene, or antioncogene, is a gene that protects a cell from one step on the path to cancer. When this gene mutates to cause a loss or reduction in its function, the cell can progress to cancer, usually in combination with other genetic changes. Tumor suppressor genes can be grouped into categories including caretaker genes, gatekeeper genes, and landscaper genes; the classification schemes are continually evolving.
      Examples include:
      Gene Associated cancers
      p53 Common to many cancers, Li-Fraumeni syndrome
      APC Colorectal cancer
      BRCA1 Breast and ovarian cancer
      BRCA2 Breast and ovarian cancer
      NF1 Neurofibromatosis
      Rb Retinoblastoma
      WT1 Wilm’s tumour

    • This question is part of the following fields:

      • Clinical Sciences
      25.3
      Seconds
  • Question 12 - A 52-year-old woman with polycystic kidney disease and a slowly rising creatinine, which...

    Correct

    • A 52-year-old woman with polycystic kidney disease and a slowly rising creatinine, which was 320 μmol/L at her last clinic visit 3 weeks ago, is brought into the Emergency Department having been found collapsed at home by her partner. She is now fully conscious but complains of a headache.   What is the most likely diagnosis?

      Your Answer: Subarachnoid haemorrhage

      Explanation:

      One of the most important complications in patients with PKD is being affected by berry aneurysms that may burst, causing a subarachnoid haemorrhage, which seems to be the case in this patient.

    • This question is part of the following fields:

      • Nephrology
      125.9
      Seconds
  • Question 13 - A 20-year-old male presented to the clinic with a long term history of...

    Correct

    • A 20-year-old male presented to the clinic with a long term history of pins and needles sensation in both hands. He also has prognathism. He also gives a history of recent onset right upper quadrant pain after being started on a new medication for his condition. Which of the following medications acting on his endocrine system can be responsible for this adverse effect?

      Your Answer: Octreotide

      Explanation:

      The patient (known case of acromegaly) seems to have developed cholelithiasis (presenting with right upper quadrant pain) probably due to octreotide.

      It is a long-acting analogue of somatostatin which is released from D cells of the pancreas and inhibits the release of growth hormone, glucagon, and insulin.

      Uses
      – Acute treatment of variceal haemorrhage
      – Acromegaly
      – Carcinoid syndrome
      – Prevent complications following pancreatic surgery
      – VIPomas
      – Refractory diarrhoea

      Adverse effects
      Gallstones (secondary to biliary stasis)

      Other options:
      – Bromocriptine – a dopamine agonist with side effects arising from its stimulation of the brain vomiting centre.
      – Desmopressin – predominantly used in patients with diabetes insipidus by increasing the presence of aquaporin channels in the distal collecting duct to increase water reabsorption from the kidneys. The main side effects include headache and facial flushing due to hypertension.
      – Metformin – mainly reduces hepatic gluconeogenesis in patients with type 2 diabetes, common side effects include diarrhoea, vomiting, and lactic acidosis
      – Levothyroxine – synthetic thyroxine used in patients with hypothyroidism, common side effects result from incorrect dosing and mimic the symptoms of hyperthyroidism.

    • This question is part of the following fields:

      • Pharmacology
      258.3
      Seconds
  • Question 14 - A 43 year-old female artist with no past medical history presents to the...

    Correct

    • A 43 year-old female artist with no past medical history presents to the emergency department with a 2-day history of pins and needles in the lower limbs, and progressive walking difficulties. She states she had diarrhoea 1 week ago. On examination, there is a loss of pinprick sensation noted to the lower limbs from mid-thigh distally and in the upper limbs from MCP joints distally. There is bilateral weakness of ankle dorsiflexion, noted at 3/5, and knee flexion and extension weakness, noted at 4/5 bilaterally. Power in upper and lower limbs is otherwise normal. Knee and ankle deep tendon reflexes are absent. Which of the following is the most likely diagnosis?

      Your Answer: Guillain-Barre syndrome

      Explanation:

      Guillain-Barre syndrome is an immune mediated demyelination of the peripheral nervous system often triggered by an infection (classically Campylobacter jejuni). Characteristic features include progressive weakness of all four limbs, and it is classically ascending, affecting the lower extremities first. Sensory symptoms tend to be mild.

      Functional neurological syndrome can be discounted due to presence of hard neurological signs. Multiple sclerosis can be excluded because of the presence of lower motor neuron signs and absence of upper motor neuron signs. Chronic inflammatory demyelinating polyneuropathy is the chronic form of Guillain-Barre syndrome.

    • This question is part of the following fields:

      • Neurology
      107.4
      Seconds
  • Question 15 - A 43 year old female presents with an array of symptoms including weakness,...

    Incorrect

    • A 43 year old female presents with an array of symptoms including weakness, lethargy, dysphagia, dry mouth, gritty sensation in her eyes and increased photosensitivity. In order to confirm the suspected diagnosis, which of the following tests should be performed?

      Your Answer: Oesophagogastroscopy

      Correct Answer: Labial gland biopsy

      Explanation:

      To confirm the diagnosis, especially in patients with negative anti-Ro or anti-La antibodies, labial gland biopsy is done. In performing a labial biopsy, the surgeon typically makes a shallow 1/2 inch wide incision on either side of the inner lip after numbing the area with a local anaesthetic. Schirmer’s test determines whether the eye produces enough tears to keep it moist. This test can be done for ocular symptoms of Sjogren syndrome but is of no diagnostic importance as it can be positive with many other diseases.

    • This question is part of the following fields:

      • Rheumatology
      11.9
      Seconds
  • Question 16 - A 30 year old male is reviewed following treatment using cognitive behaviour therapy...

    Incorrect

    • A 30 year old male is reviewed following treatment using cognitive behaviour therapy for bulimia. He thinks there has been no improvement in his condition and is interested in using pharmacological therapy. Which of the following is most suitable?

      Your Answer: Low-dose citalopram

      Correct Answer: High-dose fluoxetine

      Explanation:

      Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviours such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

      According to the DSM-5, the official diagnostic criteria for bulimia nervosa are:
      Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
      Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
      A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).
      Recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
      The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for three months.
      Self-evaluation is unduly influenced by body shape and weight.
      The disturbance does not occur exclusively during episodes of anorexia nervosa.

      Antidepressants as a group – particularly selective serotonin reuptake inhibitors (SSRIs) – are the mainstay of pharmacotherapy for bulimia nervosa. These may be helpful for patients with substantial concurrent symptoms of depression, anxiety, obsessions, or certain impulse disorder symptoms. They may be particularly good for patients who have not benefited from or had suboptimal response to suitable psychosocial therapy or who have a chronic, difficult course in combination with other treatments.

      Food and Drug Administration (FDA) approved treatments
      Fluoxetine (Prozac): Initial dose 20 mg/d with advance over 1–2 weeks to 60 mg/d in the morning as tolerated. Some patients may need to begin at a lower dose if side effects are intolerable. A maximum dose of 80 mg/d may be used in some cases.

    • This question is part of the following fields:

      • Psychiatry
      64.6
      Seconds
  • Question 17 - An 80-year-old female presents to OPD with itching hands, elbows, axillae and groin....

    Incorrect

    • An 80-year-old female presents to OPD with itching hands, elbows, axillae and groin. Other members residing with her at the retirement home also have similar complaints. Which of the following is the most likely diagnosis?

      Your Answer: Scabies

      Correct Answer:

      Explanation:

      Scabies is due to an infestation of Sarcoptes scabiei and most commonly presents with these symptoms. The organism resides in burrows in a pattern specifically affecting the interdigital spaces and the skin folds of the arms and legs. The infection spreads from one person to another, especially in populated communities, through close contact.
      Henoch-Schönlein purpura is a type of vascular inflammation.
      Psoriasis rash is characterised by scaly plaques affecting the extensor surfaces of the body. Pemphigus vulgaris and bullous pemphigoid both are bullous disorders of the skin. They may present as crusted, weeping, diffuse lesions and there may be involvement in other sites; erosions in the mouth are typically involved in pemphigus vulgaris. Bullous pemphigoid involves the flexural areas and may be associated with a new medication.

    • This question is part of the following fields:

      • Infectious Diseases
      1199.8
      Seconds
  • Question 18 - A 50-year-old woman is investigated for weight loss and anaemia. Clinical examination reveals...

    Correct

    • A 50-year-old woman is investigated for weight loss and anaemia. Clinical examination reveals splenomegaly associated with pale conjunctivae. Her full blood count (FBC) report shows: Hb: 10.9 g/dL, Plts: 702 x 10^9/L, WCC: 56.6 x 10^9/L. Moreover, all stages of granulocyte maturation are seen on her blood film. Given the likely diagnosis, what should be the most appropriate treatment?

      Your Answer: Imatinib

      Explanation:

      This patient is a case of chronic myeloid leukaemia (CML) and should be started on imatinib as the first-line drug of choice.

    • This question is part of the following fields:

      • Haematology & Oncology
      29.4
      Seconds
  • Question 19 - A 25 yr. old previously well male presented with chest discomfort and difficulty...

    Incorrect

    • A 25 yr. old previously well male presented with chest discomfort and difficulty in breathing while running to the bus. Symptoms disappeared after resting. But the symptoms reappeared whilst he was climbing the stairs. On examination he was not dyspnoeic at rest. BP was 110/70 mmHg and pulse rate was 72 bpm. His heart sounds were normal. There was an additional clicking noise in the fourth left intercostal space which is heard with each heart beat. Which of the following is the most probable cause for his presentation?

      Your Answer:

      Correct Answer: Spontaneous pneumothorax

      Explanation:

      The given history is more compatible with spontaneous pneumothorax. Left-sided pneumothoraxes may be associated with a clicking noise, which is heard with each heart-beat and can sometimes be heard by the patient.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds
  • Question 20 - With respect to liver cirrhosis, which of the following statements is correct? ...

    Incorrect

    • With respect to liver cirrhosis, which of the following statements is correct?

      Your Answer:

      Correct Answer: The final common pathway of hepatic fibrosis is mediated by the hepatic stellate cell

      Explanation:

      The development of hepatic fibrosis reflects an alteration in the normally balanced processes of extracellular matrix production and degradation. [6] The extracellular matrix, the normal scaffolding for hepatocytes, is composed of collagens (especially types I, III, and V), glycoproteins, and proteoglycans. Increased collagen in the space of Disse (space b/w sinusoids and hepatocytes) leads to capillarization of sinusoids, and stellate cells also have contractile properties when activated. This is fibrosis processes. This can lead to the development of portal hypertension.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Nephrology (2/3) 67%
Clinical Sciences (1/4) 25%
Endocrinology (0/2) 0%
Pharmacology (1/2) 50%
Gastroenterology (2/3) 67%
Neurology (1/1) 100%
Infectious Diseases (0/1) 0%
Haematology & Oncology (0/1) 0%
Cardiology (1/1) 100%
Passmed