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Question 1
Correct
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A 60 yr. old previously well male patient was admitted with acute severe central chest pain associated with excessive sweating and nausea for the past 45 minutes. On examination he was found to have xanthelasma. His blood pressure was 170/100 mmHg and pulse rate was 104 bpm. His ECG showed ST elevation more than 2mm in leads II, III and aVF. His troponin T was 120 ng/ml. His FBC and renal functions were normal. He was given aspirin, clopidogrel, morphine and IV 5mg of atenolol. Which of the following is the most appropriate next step?
Your Answer: Immediate referral to cardiologist for primary angioplasty
Explanation:The diagnosis is acute inferior ST elevation myocardial infarction so the most appropriate management is primary angioplasty.
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This question is part of the following fields:
- Cardiology
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Question 2
Correct
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Which one of the following features is least associated with Waldenström's macroglobulinemia?
Your Answer: Bone pain
Explanation:Waldenström’s macroglobulinemia (also called lymphoplasmacytic lymphoma) is an uncommon type of non-Hodgkin lymphoma seen in older people. It is a lymphoplasmacytoid malignancy characterised by the secretion of a monoclonal IgM paraprotein. Its features include weight loss and lethargy; monoclonal IgM paraproteinemia; hyperviscosity syndrome leading to bilateral central retinal vein occlusion (CRVO) and hence, visual disturbances; hepatosplenomegaly and lymphadenopathy; and cryoglobulinemia. It is not, however, associated with bone pain.
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This question is part of the following fields:
- Haematology & Oncology
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Question 3
Incorrect
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A 30-year-old man has been unwell for the last 3 weeks and now developed a rash. Chickenpox is diagnosed. What is the appropriate treatment?
Your Answer: No medication
Correct Answer: Acyclovir
Explanation:You may treat chickenpox with acyclovir if it is commenced within the first 24 hours of the rash’s appearance. Erythromycin, doxycycline, and ampicillin would not help because it’s a viral infection (Varicella) not a bacterial infection.
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This question is part of the following fields:
- Infectious Diseases
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Question 4
Incorrect
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A 78 year old woman presents to the clinic complaining of left sided temporal headaches and jaw claudication that has been going on for a month. A left temporal artery biopsy is negative. Results show: Hb: 130g/l Platelets: 359*109/L, WBC: 10*109/L, CRP: 89mg/l Which of the following options would be the next best step in the management of this patient?
Your Answer: CT brain
Correct Answer: Commence prednisolone
Explanation:Temporal arteritis is a chronic large- and medium-sized vessel vasculitis that typically involves the temporal arteries. Classical symptoms include temporal headaches, jaw claudication, amaurosis fugax. Physical exam shows scalp tenderness, palpation of the temporal area may demonstrate an absent pulse, knot-like swelling and vision loss. Lab results reveal an increased erythematous sedimentation rate and C-reactive protein. Temporal artery biopsy confirms the diagnosis. Management approach: high-dose systemic corticosteroids should be promptly administered even before the diagnosis is established. Temporal artery biopsy confirms the diagnosis. Inability to manage this or administer glucocorticoids might lead to development of blindness.
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This question is part of the following fields:
- Rheumatology
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Question 5
Correct
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A 45-year-old woman is HIV positive. She is very concerned that she is at increased risk of cancer. Which one of the following cancers is NOT increased in HIV positive people?
Your Answer: Breast cancer
Explanation:Breast cancer has a lower incidence in HIV positive patients. Seminoma, Hodgkin’s disease, anal cancer, and non-small cell lung cancer are all increased incidence. Memorize this breast cancer fact.
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This question is part of the following fields:
- Infectious Diseases
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Question 6
Incorrect
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A diagnosed case of scabies presented in OPD for some medical advice. Which of the following statements best suits scabies?
Your Answer: Is best treated by salicylate emulsion
Correct Answer:
Explanation:Scabies is an infection caused by a microscopic mite known as Sarcoptes scabies. The chief presenting complaint is itching especially in skin folds and mostly during night. It spreads from one person to another through skin contact, and therefore it is more prevalent in crowded areas like hospitals, hostels and even at homes where people live in close contact with each other. Treatment options include benzyl benzoate, ivermectin, sulphur and permethrin.
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This question is part of the following fields:
- Dermatology
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Question 7
Incorrect
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A 50 yr. old smoker with a history of hypertension presented with acute severe chest pain and acute myocardial infarction was diagnosed. Which of the following is a contraindication for thrombolysis?
Your Answer: Blood pressure 160/110 mmHg
Correct Answer: History of likely ischaemic stroke within the past month
Explanation:Absolute contraindications for fibrinolytic use in STEMI
Prior intracranial haemorrhage (ICH)
Known structural cerebral vascular lesion
Known malignant intracranial neoplasm
Ischemic stroke within 3 months
Suspected aortic dissection
Active bleeding or bleeding diathesis (excluding menses)
Significant closed head trauma or facial trauma within 3 months
Intracranial or intraspinal surgery within 2 months
Severe uncontrolled hypertension (unresponsive to emergency therapy)
For streptokinase, prior treatment within the previous 6 months -
This question is part of the following fields:
- Cardiology
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Question 8
Correct
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A baby is born to a mother who is known to have chronic hepatitis B. The mothers latest results are as follows: HBsAg: Positive, HBeAg: Positive. What is the most appropriate strategy for reducing the vertical transmission rate?
Your Answer: Give the newborn hepatitis B vaccine + hepatitis B immunoglobulin
Explanation:The Green Book guidelines report in an active infection (HBeAg+ and HBsAg+) to give the vaccine as well as immunoglobulin. If antibodies are present it is not active infection (anti-Hbe) and then in that case only the vaccine, and no immunoglobulin, would be given. The presence of HBeAg means a person is infectious and can transmit to other people.
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This question is part of the following fields:
- Gastroenterology
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Question 9
Correct
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A 40-year-old woman presents to her GP with malaise, anorexia, and weight loss. Screening blood samples reveals urea of 50.1 mmol/l and serum creatinine of 690 μmol/l. Her past history includes frequent headaches, but nothing else of note. She has, however, failed to attend her routine ‘well-woman’ appointments. Ultrasound reveals bilateral hydronephrosis and a suspicion of a central pelvic mass. What diagnosis is most likely to be responsible for this woman’s hydronephrosis?
Your Answer: Cervical carcinoma
Explanation:The patient’s history of recent weight loss and malaise, paired with enlarged kidneys and renal failure, as well as a suspected central pelvic mass on ultrasound, gives a suspicion of cervical carcinoma.
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This question is part of the following fields:
- Nephrology
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Question 10
Incorrect
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A 50-year-old man is found incidentally to have hypercalcaemia during a routine health screen. Which one of the following biochemical findings would be most suggestive of primary hyperparathyroidism rather than any other cause of hypercalcaemia?
Your Answer: Low serum concentration of calcitriol (1,25- dihydroxycholecalciferol)
Correct Answer: Serum PTH concentration within the normal range
Explanation:Primary hyperparathyroidism (PHPT) is diagnosed based upon levels of blood calcium and parathyroid hormone (PTH). In most people with PHPT, both levels are higher than normal. Occasionally, a person may have an elevated calcium level and a normal or minimally elevated PTH level. Since PTH should normally be low when calcium is elevated, a minimally elevated PTH is considered abnormal and indicates PHPT.
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This question is part of the following fields:
- Endocrinology
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SESSION STATS - PERFORMANCE PER SPECIALTY
