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  • Question 1 - A 60 yr. old patient with hypertension attended his regular clinic. His compliance...

    Incorrect

    • A 60 yr. old patient with hypertension attended his regular clinic. His compliance was poor. His blood pressure was 180/100 mmHg. His pulse rate was 85 bpm which was irregularly irregular. On examination there was bibasal crepitation. No murmurs were heard. What is the most likely cause for these findings?

      Your Answer: Occlusive coronary atherosclerosis

      Correct Answer: Left ventricular hypertrophy

      Explanation:

      Left ventricular hypertrophy due to long standing hypertension is the most probable cause. The irregularly irregular pulse was suggestive of atrial fibrillation, which is due to diastolic dysfunction. Poor ventricular filling causes pulmonary congestion which manifests as bibasal crepitations.

    • This question is part of the following fields:

      • Cardiology
      77
      Seconds

  • Question 2 - A study is developed to assess a new anti-hypertensive drug and two groups...

    Incorrect

    • A study is developed to assess a new anti-hypertensive drug and two groups of patients are randomly chosen. The first group takes an established anti-hypertensive drug for 3 months and the second group receives the new drug, again for 3 months. To assess the efficacy of the new drug, blood pressure is measured before and after taking the drug in both groups of patients. After a period of 1 month off medication, the groups swap medication and blood pressure is measured again, finally the difference in blood pressure after receiving each drug is calculated. Which of the following significance tests would you apply to assess the results of the study?

      Your Answer: Mann-Whitney test

      Correct Answer: Student's paired t-test

      Explanation:

      A t test is a type of statistical test that is used to compare the means of two groups. It is one of the most widely used statistical hypothesis tests in pain studies. There are two types of statistical inferences: parametric and nonparametric methods. Parametric methods refer to a statistical technique in which one defines the probability distribution of probability variables and makes inferences about the parameters of the distribution. In cases in which the probability distribution cannot be defined, nonparametric methods are employed. T tests are a type of parametric method; they can be used when the samples satisfy the conditions of normality, equal variance, and independence. In this case the data is parametric, and they belong to the same patients, so a paired t test should be used.

    • This question is part of the following fields:

      • Clinical Sciences
      46.2
      Seconds

  • Question 3 - A 27-year-old consultant who has a family history of retinitis pigmentosa is reviewed...

    Incorrect

    • A 27-year-old consultant who has a family history of retinitis pigmentosa is reviewed in the ophthalmology clinic. He reports worsening vision over the past few months. During fundoscopy, which of the following findings would most support a diagnosis of retinitis pigmentosa?

      Your Answer: Drusen with haemorrhagic atrophic changes concentrated at the periphery of the retina

      Correct Answer: Black bone spicule-shaped pigmentation in the peripheral retina

      Explanation:

      Retinitis pigmentosa is a genetic disorder primarily affecting the peripheral retina resulting in tunnel vision. Night blindness is often the initial sign. Fundoscopy exam reveals black bone spicule-shaped pigmentation in the peripheral retina, and mottling of the retinal pigment epithelium.

    • This question is part of the following fields:

      • Ophthalmology
      26.8
      Seconds

  • Question 4 - A 54-year-old man is found collapsed in the street and is brought to...

    Incorrect

    • A 54-year-old man is found collapsed in the street and is brought to the A&E. The results from the blood tests reveal Calcium = 1.62mmol/l and Albumin = 33g/l. The man is known to have a history of alcoholic liver disease. Which of the following is the best management regarding his calcium levels?

      Your Answer: 10ml of 10% calcium chloride over 10 minutes

      Correct Answer: 10ml of 10% calcium gluconate over 10 minutes

      Explanation:

      Acute, symptomatic hypocalcaemia is treated with 10ml of 10% calcium gluconate over 10 minutes.

    • This question is part of the following fields:

      • Clinical Sciences
      27.3
      Seconds

  • Question 5 - A 65 yr. old previously well man was referred due to an abnormal...

    Correct

    • A 65 yr. old previously well man was referred due to an abnormal heart sound which was detected during a medical check up. On examination he looked well. His blood pressure was 120/70 mmHg and pulse rate was 68 bpm which was regular. His jugular venous pressure was not elevated and he didn't have ankle oedema. He had an early diastolic murmur, best heard at the left sternal edge, which was more clear in expiration when the patient leant forward. His lungs were clear. His FBC, Urea and electrolytes, LFTs and lipid profile were normal. His ECG showed sinus rhythm. His chest X-ray was normal. Echocardiography showed mild to moderate aortic regurgitation with normal left ventricular size and normal function. Which of the following is the most appropriate way of managing this patient?

      Your Answer: Start him on an angiotensin-converting enzyme (ACE) inhibitor

      Explanation:

      Although this patient’s left ventricular function is normal at the time of examination, there is chance of deterioration of it due to aortic regurgitation. It is found that ACE inhibitors slow the development of left ventricular dysfunction. So this patient should be started on an ACE inhibitor.

    • This question is part of the following fields:

      • Cardiology
      86.3
      Seconds

  • Question 6 - All of the following are true regarding carcinoid syndrome, except? ...

    Incorrect

    • All of the following are true regarding carcinoid syndrome, except?

      Your Answer: Flushing attacks may be associated with bronchoconstriction, periorbital oedema, salivation and excessive lacrimation

      Correct Answer: Pharmacological blockade is clinically useful in only 10% of patients

      Explanation:

      For medical management of carcinoid syndrome, there are two somatostatin analogues available, Octreotide and Lanreotide. Somatostatin is an amino acid peptide which is an inhibitory hormone, which is synthesized by paracrine cells located ubiquitously throughout the gastrointestinal tract. Both somatostatin analogues provide symptom relief in 50% to 70% of patients and biochemical response in 40% to 60% patients. Many studies have shown that Octreotide and Lanreotide also inhibit the proliferation of tumour cells.

    • This question is part of the following fields:

      • Endocrinology
      17.5
      Seconds

  • 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: IV pamidronate

      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
      316.3
      Seconds

  • Question 8 - Choose the correct statement regarding leptin: ...

    Incorrect

    • Choose the correct statement regarding leptin:

      Your Answer: High levels decrease appetite

      Correct Answer: Is produced mainly by the hypothalamus

      Explanation:

      Leptin, a 167–amino acid hormone, was discovered in 1994 and is secreted mainly by adipocytes. Plasma leptin levels are significantly correlated with body mass index (BMI) and the total amount of body fat.

    • This question is part of the following fields:

      • Clinical Sciences
      26.8
      Seconds

  • Question 9 - A 46 year old male, known with Rheumatoid Arthritis presents with a swollen...

    Incorrect

    • A 46 year old male, known with Rheumatoid Arthritis presents with a swollen and painful right ankle. No drug allergies are reported. On examination, the vitals are as follows: Temp: 38.8 BP: 90/60 mmHg Pulse: 110/min. Right ankle examination reveals tenderness, warmth, erythema and tense joint effusion. Blood samples including blood cultures are collected and fluid resuscitation is initiated. Which of the following interventions would be most appropriate for this man?

      Your Answer:

      Correct Answer: Administer i.v. flucloxacillin, and arrange joint aspiration urgently

      Explanation:

      Although microscopic analysis of joint fluid aspirate and culture is the basis of septic arthritis diagnosis and should usually be collected before the administration of antibiotics, the patient is showing signs of septic shock. A delay in antibiotics might lead to worsening of symptoms so they are administered first.

    • This question is part of the following fields:

      • Rheumatology
      0
      Seconds

  • Question 10 - Which of the following is the site where B-type natriuretic peptide is mainly...

    Incorrect

    • Which of the following is the site where B-type natriuretic peptide is mainly secreted?

      Your Answer:

      Correct Answer: Ventricular myocardium

      Explanation:

      B-type natriuretic peptide (BNP) is secreted mainly from the left ventricle and it is secreted as a response to stretching caused by increased ventricular blood volume.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

  • Question 11 - A 55-year-old man develops central abdominal pain a few hours after having an...

    Incorrect

    • A 55-year-old man develops central abdominal pain a few hours after having an Endoscopic Retrograde Cholangiopancreatography (ERCP) performed. Investigations reveal the following: Amylase: 545 u/dL, Erect chest x-ray: Normal heart and lungs and no free air noted. What is the most appropriate management?

      Your Answer:

      Correct Answer: Intravenous fluids + analgesia

      Explanation:

      A very common complication after ERCP is post-ERCP pancreatitis, which based on the clinical scenario , this man has. The treatment for this is pain control, lots of intravenous fluids, and traditionally bowel rest, although more recent evidence suggests early feeding is better.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds

  • Question 12 - You want to compare a new oral hypoglycaemic drug with an existing treatment,...

    Incorrect

    • You want to compare a new oral hypoglycaemic drug with an existing treatment, which would also lower HbA1c. Which study design would you choose?

      Your Answer:

      Correct Answer: Superiority trial

      Explanation:

      When the aim of the randomized controlled trial (RCT) is to show that one treatment is superior to another, a statistical test is employed and the trial (test) is called a superiority trial (test).

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds

  • Question 13 - A paediatrician has concerns that a 6-month-old baby is deaf. His mom gives...

    Incorrect

    • A paediatrician has concerns that a 6-month-old baby is deaf. His mom gives history of her having a sore throat, fever and lymphadenitis during pregnancy. Which organism causes such manifestations?

      Your Answer:

      Correct Answer:

      Explanation:

      The best answer is cytomegalovirus. The mother was infected during the pregnancy and the baby has developed cytomegalo-inclusion syndrome. Histologically, it is identified by viral particles surrounded by lysosomes.

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds

  • Question 14 - Which one of the following is the most common cause of hypothyroidism in...

    Incorrect

    • Which one of the following is the most common cause of hypothyroidism in the UK?

      Your Answer:

      Correct Answer: Hashimoto's thyroiditis

      Explanation:

      Hashimoto thyroiditis is the most common cause of hypothyroidism in developed countries. In contrast, worldwide, the most common cause of hypothyroidism is an inadequate dietary intake of iodine. This disease is also known as chronic autoimmune thyroiditis and chronic lymphocytic thyroiditis.

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds

  • Question 15 - A 32 year old Indian male presents to the clinic with fever, cough...

    Incorrect

    • A 32 year old Indian male presents to the clinic with fever, cough and an enlarged cervical lymph node. Examination reveals a caseating granuloma in the lymph node. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: TB adenitis

      Explanation:

      Tuberculous lymphadenitis is a chronic, specific granulomatous inflammation of the lymph node with caseation necrosis, caused by infection with Mycobacterium tuberculosis or a related bacteria. The characteristic morphological element is the tuberculous granuloma (caseating tubercle).

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds

  • Question 16 - What percentage of values lie within 3 standard deviations of the mean in...

    Incorrect

    • What percentage of values lie within 3 standard deviations of the mean in a normal distribution?

      Your Answer:

      Correct Answer: 99.70%

      Explanation:

      Normal distribution describes the spread of many biological and clinical measurements. Usually, 68.3% lies within 1 standard deviation (SD) of the mean, 95.4% lies within 2 SD of the mean and 99.7% lies within 3 SD of the mean.

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds

  • Question 17 - Among the following which is the beneficial effect of nitro-glycerine? ...

    Incorrect

    • Among the following which is the beneficial effect of nitro-glycerine?

      Your Answer:

      Correct Answer: Dilation of systemic veins

      Explanation:

      Dilation of systemic veins is a beneficial effect of nitro-glycerine.

      Administration of nitro-glycerine results in the dilation of systemic veins and decrease of myocardial wall tension and oxygen demand. Dilatation of systemic veins can cause reduced systemic vascular resistance leading to reduced cardiac workload thus reducing anginal symptoms secondary to demand ischemia.

      This is accompanied by vasodilation of large and medium-sized coronary arteries with increased coronary blood flow to the sub endocardium.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds

  • Question 18 - A 50-year-old woman is referred to the outpatient clinic with a 6-month history...

    Incorrect

    • A 50-year-old woman is referred to the outpatient clinic with a 6-month history of diarrhoea. She has had intermittent loose normal-coloured stools 2-3 times a day. She also has up to 10 hot flushes a day but thinks she is entering menopause; her GP has recently started her on hormone replacement therapy. 15 years ago she had a normal colonoscopy after presenting with abdominal pain and intermittent constipation. She has asthma controlled by inhalers, hypertension controlled by ACE inhibitors and hypothyroidism controlled by thyroxine. She smoked 10 cigarettes a day for the last 30 years and drinks alcohol about 14 units/week. On examination, she looks hot and flushed. She is afebrile. Her pulse is regular 92bpm and her BP is 164/82 mmHg. Her respirator rate is 20 breaths/min at rest and she sounds quite wheezy. A widespread polyphonic expiratory wheeze can be heard on chest auscultation. Her abdomen is soft. Her liver is enlarged 4 cm below the right costal margin but not-tender. Results of blood tests show: Na 140 mmol/L, K 4.8 mmol/L, Glucose 9.8 mmol/L, Albumin 41 g/l, ALT 94 U/l, ALP 61 U/l, Bilirubin 18 mmol/L, Ca 2.47 mmol/L, WCC 10.1 × 109/L, Hb 12.2 g/dL, MCV 90.5 fl, Platelets 234 × 109 /l, PT 13 s. Chest X-ray is normal. Ultrasound of the liver shows an enlarged liver containing three ill-defined mass lesions in the right lobe. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Carcinoid syndrome

      Explanation:

      Carcinoid tumours are of neuroendocrine origin and derived from primitive stem cells in the gut wall, especially the appendix. They can be seen in other organs, including the lungs, mediastinum, thymus, liver, bile ducts, pancreas, bronchus, ovaries, prostate, and kidneys. While carcinoid tumours tend to grow slowly, they have the potential to metastasise.
      Signs and symptoms seen in larger tumours may include the following:
      – Periodic abdominal pain: Most common presentation for a small intestinal carcinoid; often associated with malignant carcinoid syndrome.
      – Cutaneous flushing: Early and frequent (94%) symptom; typically affects head and neck.
      – Diarrhoea and malabsorption (84%): Watery, frothy, or bulky stools, gastrointestinal (GI) bleed or steatorrhea; may or may not be associated with abdominal pain, flushing, and cramps.
      – Cardiac manifestations (60%): Valvular heart lesions, fibrosis of the endocardium; may lead to heart failure with tachycardia and hypertension.
      – Wheezing or asthma-like syndrome (25%): Due to bronchial constriction; some tremors are relatively indolent and result in chronic symptoms such as cough and dyspnoea.
      – Pellagra with scale-like skin lesions, diarrhoea and mental disturbances.
      – Carcinoid crisis can be the most serious symptom of the carcinoid tumours and life-threatening. It can occur suddenly or after stress, including chemotherapy and anaesthesia.

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds

  • Question 19 - Choose the cell organelle involved in the synthesis of lipids: ...

    Incorrect

    • Choose the cell organelle involved in the synthesis of lipids:

      Your Answer:

      Correct Answer: Smooth endoplasmic reticulum

      Explanation:

      The Smooth endoplasmic reticulum (ER) is the major site at which membrane lipids are synthesized in eukaryotic cells. Because they are extremely hydrophobic, lipids are synthesized in association with already existing cellular membranes rather than in the aqueous environment of the cytosol. Although some lipids are synthesized in association with other membranes, most are synthesized in the ER. They are then transported from the ER to their ultimate destinations either in vesicles or by carrier proteins.

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds

  • Question 20 - 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 21 - A 21-year-old gentleman presents with facial and ankle swelling. This has slowly been...

    Incorrect

    • A 21-year-old gentleman presents with facial and ankle swelling. This has slowly been developing over the past week. During the review of systems, he describes passing ‘frothy’ urine. A urine dipstick shows protein +++.   What is the most likely cause of this presentation?

      Your Answer:

      Correct Answer: Minimal change disease

      Explanation:

      Minimal change glomerulonephritis usually presents as nephrotic syndrome wherein the patient (usually a young adult) will present with proteinuria, oedema, and impaired kidney function, which were evident in this patient.

    • This question is part of the following fields:

      • Nephrology
      0
      Seconds

  • Question 22 - A 36-year-old lady presents to the emergency department with right upper quadrant pain....

    Incorrect

    • A 36-year-old lady presents to the emergency department with right upper quadrant pain. She has also noticed that her skin seems slightly yellower over the last week or so and you notice a yellow tinge to her sclera. On further questioning, she complains of itching of her arms. Her only past medical history of note includes ulcerative colitis for which she takes mesalazine. Given her presentation, what is the best investigation to diagnose the most likely underlying condition?

      Your Answer:

      Correct Answer: ERCP (endoscopic retrograde cholangiopancreatography)

      Explanation:

      With biliary obstructive symptoms in a patient with ulcerative colitis, one should immediately think of primary sclerosing cholangitis (PSC). PSC is characterized by inflammation and fibrosis of the intrahepatic and extrahepatic ducts. The best diagnostic test for PSC is ERCP. ANCA antibiotics may be positive, but not the best test to DIAGNOSE THE CONDITION. The same can be said of serum transaminase levels– they will be abnormal but nonspecific. While a liver ultrasound may be helpful, it is not the best test. Liver biopsy would be used to stage the PSC later.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds

  • Question 23 - What do T-helper cells of the Th2 subset typically secrete? ...

    Incorrect

    • What do T-helper cells of the Th2 subset typically secrete?

      Your Answer:

      Correct Answer: IL-4, IL-5, IL-6, IL-10, IL-13

      Explanation:

      Interleukin-4 (IL-4), IL-5 and IL-13, the signature cytokines that are produced during type 2 immune responses, are critical for protective immunity against infections of extracellular parasites and are responsible for asthma and many other allergic inflammatory diseases. Although many immune cell types within the myeloid lineage compartment including basophils, eosinophils and mast cells are capable of producing at least one of these cytokines, the production of these “type 2 immune response-related” cytokines by lymphoid lineages, CD4 T helper 2 (Th2) cells and type 2 innate lymphoid cells (ILC2s) in particular, are the central events during type 2 immune responses.

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds

  • Question 24 - Regarding the pathophysiology of diabetes mellitus, which of the following is true? ...

    Incorrect

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

      Your Answer:

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

      Explanation:

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

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds

  • Question 25 - A 34-year-old's chest x-ray showed diffuse bilateral alveolar shadows. He also suffers from...

    Incorrect

    • A 34-year-old's chest x-ray showed diffuse bilateral alveolar shadows. He also suffers from shortness of breath, weight loss and dry cough due to Kaposi's sarcoma but no fever was noted. Which is the most likely causative organism?

      Your Answer:

      Correct Answer: Pneumocystis jiroveci

      Explanation:

      Pneumocystis Jiroveci. This causative organism is responsible for pneumonia in individuals that have a compromised immune system. Symptoms include cyanosis, dry cough and in some cases, diffuse bilateral alveolar shadows on CXR. Co-trimoxazole is normally the treatment for this.

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds

  • Question 26 - A 43 year old female presented with a 5 day history of a...

    Incorrect

    • A 43 year old female presented with a 5 day history of a productive cough with rusty coloured sputum. Chest X-ray showed lobar consolidation on her left side. The most likely causative organism would be?

      Your Answer:

      Correct Answer: Streptococcus pneumoniae

      Explanation:

      Streptococcus pneumonia is the chief causative organism for lobar pneumonia in this age group patients. Typically patients present with rusty coloured sputum and a cough. Pneumocystis jiroveci is responsible for causing pneumocystis pneumonia among immunocompromised patients.

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds

  • Question 27 - Which is NOT a poor prognostic factor for patients with malignant melanoma? ...

    Incorrect

    • Which is NOT a poor prognostic factor for patients with malignant melanoma?

      Your Answer:

      Correct Answer: Diameter of melanoma > 6 mm

      Explanation:

      Features that affect prognosis are tumour thickness in millimetres (Breslow’s depth – the deeper the Breslow thickness the poorer the prognosis.), depth related to skin structures (Clark level – the level of invasion through the dermis), type of melanoma, presence of ulceration, presence of lymphatic/perineural invasion, presence of tumour-infiltrating lymphocytes (if present, prognosis is better), location of lesion, presence of satellite lesions, and presence of regional or distant metastasis. Malignant melanoma tends to grow radially before entering a vertical growth phase. The diameter it reaches has not been found to be a prognostic factor.

    • This question is part of the following fields:

      • Dermatology
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  • Question 28 - A 16 year old previously well male presents with a 4 day history...

    Incorrect

    • A 16 year old previously well male presents with a 4 day history of fever, lethargy and a generalized macular rash. There is no significant previous medical history and the patient has not travelled abroad either. Vitals are as follows: Temp: 38.5 BP: 125/75mmHg Pulse: 100/min On auscultation the chest was clear and no heart murmur was heard. Examination also reveals a non blanching widespread macular rash over the chest and abdomen. There is swelling of interphalangeal joints of both hands and feet associated with mild tenderness. Lymph nodes are palpable over the supraclavicular, axillary and inguinal areas. Abdominal examination reveals palpable mass on both right and left hypochondrium. Lab results are given below: Haemoglobin (Hb) 13.5 g/dL, White cell count (WCC) 14.0 × 109/L, Platelets 380 × 109/L, Sodium 145 mmol/L, Potassium 4.8 mmol/L, Creatinine 89 μmol/L, Rheumatoid factor: Negative, Antinuclear antibody: Negative, Anti-dsDNA: Negative, ASO titre: Not detected. Electrocardiogram (ECG): Sinus rhythm. What is the most likely underlying diagnosis?

      Your Answer:

      Correct Answer: Systemic Still’s disease

      Explanation:

      People with Systemic Juvenile Idiopathic Arthritis (also known as Stills disease) can have recurrent fevers, a macular rash, joint pain, joint deformities, an enlarged liver and/or spleen, and can occasionally have polyserositis, lung involvement or pericardial effusions. Rheumatoid factor and antinuclear antibodies are usually negative. Treatment is with non-steroidal anti-inflammatory drugs (NSAIDs) and the prognosis is better than for adult rheumatoid arthritis.
      In pauciarticular Still’s disease, antinuclear antibodies are present. Large joints are affected and most patients develop classic features of seronegative spondylarthritis.

    • This question is part of the following fields:

      • Rheumatology
      0
      Seconds

  • Question 29 - A 32-year-old male who is a known case of sickle cell disease presents...

    Incorrect

    • A 32-year-old male who is a known case of sickle cell disease presents to the Accident and Emergency (A&E) department with fever, tachypnoea, and rib pain. On examination, he has a low-grade fever of 37.9°C, oxygen saturation of 95% on air, and bilateral vesicular breath sounds on chest auscultation. CXR shows opacification in the right middle zone. Which of these statements most accurately describes the initial management of this patient?

      Your Answer:

      Correct Answer: Incentive spirometry is indicated

      Explanation:

      This is a typical picture of acute chest syndrome (ACS). According to the British Committee for Standards in Haematology (BCSH), ACS is defined as ‘an acute illness characterised by fever and/or respiratory symptoms, accompanied by a new pulmonary infiltrate on chest X-ray’. ACS occurs in sequestration crisis, which is one of the four main types of crises occurring in sickle cell disease.

      The fundamentals of initial management are as follows:
      1. Oxygen therapy to maintain saturation >95%
      2. Intravenous fluids to ensure euvolemia
      3. Adequate pain relief
      4. Incentive spirometry in all patients presenting with rib or chest pain
      5. Antibiotics with cover for atypical organisms
      6. Bronchodilators if asthma co-exists with acute chest syndrome, or if there is an evidence of acute bronchospasm on auscultation
      7. Early consultation with the critical care team and haematology department

      A senior haematologist then makes a decision as to whether a simple or exchange transfusion is necessary in order to achieve a target Hb of 10.0–11.0g/dL in either instance.

      Sickle Cell Crises:
      Sickle cell anaemia is characterised by periods of good health with intervening crises:
      1. Sequestration crisis: acute chest syndrome (i.e. fever, dyspnoea, chest/rib pain, low pO2, and pulmonary infiltrates)

      2. Thrombotic (painful or vaso-occlusive) crisis: precipitated by infection, dehydration, and deoxygenation

      3. Aplastic crisis: sudden fall in haemoglobin without marked reticulocytosis, usually occurring secondary to parvovirus infection

      4. Haemolytic crisis: fall in haemoglobin secondary to haemolysis, rare type of sickle cell crises

    • This question is part of the following fields:

      • Haematology & Oncology
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      Seconds

  • Question 30 - A 65-year-old man with a history of type 2 diabetes comes to the...

    Incorrect

    • A 65-year-old man with a history of type 2 diabetes comes to the clinic for review. His HbA1c is elevated at 64 mmol/mol despite taking 1g of metformin BD. On examination, his blood pressure is 142/88 mmHg, his pulse is 82 beats per minute and regular. His BMI is 33 kg/m². A decision is made to start him on dapagliflozin. Which of the following would you expect on starting therapy?

      Your Answer:

      Correct Answer: Increased total cholesterol

      Explanation:

      Dapagliflozin works by inhibiting sodium glucose cotransporter 2 (SGLT2) and blocking resorption of glucose in the kidney, leading to an increase in urinary glucose excretion and lowering of both plasma glucose levels and body weight.
      All studies with SGLT2 inhibitors have found significant reductions in BP, with greater reductions seen in systolic (1.66 to 6.9mmHg) than diastolic (0.88 to 3.5mmHg) BP.
      While some trials have shown no change in lipid parameters, others have shown a modest but statistically significant increase in both HDL and LDL cholesterol with no effect on triglycerides or the LDL/HDL ratio.

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiology (1/2) 50%
Clinical Sciences (0/4) 0%
Ophthalmology (0/1) 0%
Endocrinology (0/1) 0%
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