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  • Question 1 - A 24-year-old woman develops hyperthyroidism 6 weeks after delivery. On examination, she has...

    Incorrect

    • A 24-year-old woman develops hyperthyroidism 6 weeks after delivery. On examination, she has a painless, firm enlarged thyroid gland. Which of the following statements is most correct regarding her probable diagnosis?

      Your Answer: Around 20% of women have some degree of thyroid dysfunction post partum

      Correct Answer: The condition is more likely in those in whom thyroid peroxidase (TPO) antibodies were positive prior to delivery

      Explanation:

      Up to 10% of postpartum women may develop lymphocytic thyroiditis (postpartum thyroiditis) in the 2-12 months after delivery. The frequency may be as high as 25% in women with type 1 diabetes mellitus.

      Some patients return spontaneously to a euthyroid state within a few months, but most patients experience a phase of hypothyroidism that takes 2 to 6 months to resolve; of this group, some develop permanent hypothyroidism. About 50% of patients, however, will develop permanent hypothyroidism within 5 years of the diagnosis of postpartum thyroiditis.

      High titres of anti-TPO antibodies during pregnancy have been reported to have high sensitivity and specificity for postpartum autoimmune thyroid disease.

    • This question is part of the following fields:

      • Endocrinology
      30.7
      Seconds
  • Question 2 - Which type of cell is responsible for the production of surfactant? ...

    Correct

    • Which type of cell is responsible for the production of surfactant?

      Your Answer: Type II pneumocyte

      Explanation:

      Type I pneumocyte: The cell responsible for the gas (oxygen and carbon dioxide) exchange that takes place in the alveoli. It is a very thin cell stretched over a very large area. This type of cell is susceptible to a large number of toxic insults and cannot replicate itself.
      Type II pneumocyte: The cell responsible for the production and secretion of surfactant (the molecule that reduces the surface tension of pulmonary fluids and contributes to the elastic properties of the lungs). The type 2 pneumocyte is a smaller cell that can replicate in the alveoli and will replicate to replace damaged type 1 pneumocytes. Alveolar macrophages are the primary phagocytes of the innate immune system, clearing the air spaces of infectious, toxic, or allergic particles that have evaded the mechanical defences of the respiratory tract, such as the nasal passages, the glottis, and the mucociliary transport system. The main role of goblet cells is to secrete mucus in order to protect the mucous membranes where they are found. Goblet cells accomplish this by secreting mucins, large glycoproteins formed mostly by carbohydrates.

    • This question is part of the following fields:

      • Respiratory
      4.9
      Seconds
  • Question 3 - A 49 year old female presents to the clinic complaining of pain in...

    Correct

    • A 49 year old female presents to the clinic complaining of pain in her left elbow that is localized to the left lateral epicondyle. She has spent the weekend painting her house. A diagnosis of lateral epicondylitis is suspected. The pain would characteristically worsen on which of the following movements?

      Your Answer: Resisted wrist extension with the elbow extended

      Explanation:

      Lateral epicondylitis (tennis elbow) is an overuse injury of the hand and finger extensor tendons that originate in the lateral humeral epicondyle that occurs following repeated or excessive pronation/supination and extension of the wrist (e.g., in racquet sports). Clinical features include pain and tenderness over the lateral epicondyle and along extensor muscles, thickening of the tendons. The examiner holds the patient’s hand with the thumb placed over the lateral epicondyle – The patient makes a fist, supinates the forearm, deviates radially, and extends the fist against the examiner’s resistance which results in pain over the lateral epicondyle. Conservative treatment includes rest, physiotherapy and orthotic braces. If this fails corticosteroids and lidocaine injections are employed. Surgery is indicated in patients with persistent symptoms despite 6 months of conservative treatment. Excision of abnormal tendon tissue; longitudinal incisions (tenotomies) in scarred and fibrotic areas to promote healing.

    • This question is part of the following fields:

      • Rheumatology
      28.8
      Seconds
  • Question 4 - From which cells is somatostatin secreted? ...

    Correct

    • From which cells is somatostatin secreted?

      Your Answer: D cells in the pancreas

      Explanation:

      The somatostatin-secreting D-cells comprise ,5% of the cells of the pancreatic islets. The D-cells have a complex morphology and may, via cellular process, interact with many more islet cells than suggested by their low number. D-cells are equipped with ATP-sensitive potassium channels (KATP channels).

    • This question is part of the following fields:

      • Clinical Sciences
      707.5
      Seconds
  • Question 5 - An elderly woman is referred with worsening chronic pulmonary disease (COPD). She smokes...

    Incorrect

    • An elderly woman is referred with worsening chronic pulmonary disease (COPD). She smokes seven cigarettes per day. Her exercise tolerance is only a few yards around the house now. Her FEV1 is 37% of predicted. What is the most appropriate intervention for this patient?

      Your Answer: Give regular low-dose inhaled fluticasone and inhaled long-acting β-agonist

      Correct Answer: Give regular high-dose inhaled fluticasone and inhaled long-acting β-agonist

      Explanation:

      The Stages of COPD:
      Mild COPD or Stage 1—Mild COPD with a FEV1 about 80 percent or more of normal.
      Moderate COPD or Stage 2—Moderate COPD with a FEV1 between 50 and 80 percent of normal.
      Severe COPD or Stage 3—Severe emphysema with a FEV1 between 30 and 50 percent of normal.
      Very Severe COPD or Stage 4—Very severe or End-Stage COPD with a lower FEV1 than Stage 3, or people with low blood oxygen levels and a Stage 3 FEV1.

      This patient has a FEV1 percent of 37 which falls within the stage 3 or severe COPD.
      During stage 3 COPD, you will likely experience significant lung function impairment. Many patients will experience an increase in COPD flare-ups or exacerbations. For some people, the increase in flare-ups means they could need to be hospitalized at times as well.

      Inhaled corticosteroid (ICS) use in combination with long-acting β2-agonists (LABAs) was shown to provide improved reductions in exacerbations, lung function, and health status. ICS-LABA combination therapy is currently recommended for patients with a history of exacerbations despite treatment with long-acting bronchodilators alone. The presence of eosinophilic bronchial inflammation, detected by high blood eosinophil levels or a history of asthma or asthma–COPD overlap, may define a population of patients in whom ICSs may be of particular benefit.

      The Towards a Revolution in COPD Health (TORCH) trial was a pivotal, double-blind, placebo-controlled, randomized study comparing salmeterol plus fluticasone propionate (50 and 500 µg, respectively, taken twice daily) with each component alone and placebo over 3 years.26 Patients with COPD were enrolled if they had at least a 10-pack-year smoking history, FEV1 <60% predicted, and an FEV1:FVC ratio ≤0.70.26 Among 6,184 randomized patients, the risk of death was reduced by 17.5% with the ICS-LABA combination vs placebo (P=0.052). ICS-LABA significantly reduced the rate of exacerbations by 25% compared with placebo (P<0.001) and improved health status and FEV1 compared with either component alone or placebo.

    • This question is part of the following fields:

      • Respiratory
      29.5
      Seconds
  • Question 6 - A 23-year-old man is being investigated for excessive bleeding following a tooth extraction....

    Incorrect

    • A 23-year-old man is being investigated for excessive bleeding following a tooth extraction. His coagulation profile shows: Plts: 173 x 10^9/L, PT: 12.9 secs, APTT: 84 secs. Which clotting factor is he most likely deficient in?

      Your Answer: Factor IX

      Correct Answer: Factor VIII

      Explanation:

      The patient is most likely a case of haemophilia A which is the genetic deficiency of clotting factor VIII in blood.

      Haemophilia is an X-linked recessive disorder of coagulation. Up to 30% of patients have no family history of the condition. Haemophilia A is more common than haemophilia B and accounts for 90% of the cases. In haemophilia B (Christmas disease), there is a deficiency of clotting factor IX.

      Characteristic features of haemophilia include hemarthrosis, haematomas, and prolonged bleeding following trauma or surgery. Coagulation profile of a haemophiliac person shows prolonged bleeding time, activated partial thromboplastin time (APTT), thrombin time (TT), but a normal prothrombin time (PT).

    • This question is part of the following fields:

      • Haematology & Oncology
      18.1
      Seconds
  • Question 7 - A 20-year-old woman presents with weakness and is found to have a serum...

    Incorrect

    • A 20-year-old woman presents with weakness and is found to have a serum potassium of 2.2 mmol/l and pH 7.1.   Which of the following would be LEAST useful in differentiating between renal tubular acidosis Types 1 and 2?

      Your Answer: Serum bicarbonate 8 mmol/l

      Correct Answer: Osteomalacia

      Explanation:

      Osteomalacia is a marked softening of the bones that can present in both type I and type II Renal Tubular Acidosis (RTA) and will thus not differentiate the two types in any case. The other measures will allow differentiation of the two types.

    • This question is part of the following fields:

      • Nephrology
      15.3
      Seconds
  • Question 8 - Double-stranded DNA is found in which of the following cell organelles? ...

    Correct

    • Double-stranded DNA is found in which of the following cell organelles?

      Your Answer: Mitochondria

      Explanation:

      Mitochondrial DNA (mtDNA) is a double-stranded molecule of 16.6 kb (Figure 1, lower panel). The two strands of mtDNA differ in their base composition, with one being rich in guanines, making it possible to separate a heavy (H) and a light (L) strand by density centrifugation in alkaline CsCl2 gradients.

    • This question is part of the following fields:

      • Clinical Sciences
      5.7
      Seconds
  • Question 9 - 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: Lymphoma of the thyroid gland

      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
      25.5
      Seconds
  • Question 10 - A 33-year-old man with a known history of alcoholic liver disease is reviewed...

    Correct

    • A 33-year-old man with a known history of alcoholic liver disease is reviewed following a suspected oesophageal variceal haemorrhage. He has been resuscitated and intravenous terlipressin has been given. His blood pressure is now 104/60 mmHg and his pulse is 84/min. What is the most appropriate intervention?

      Your Answer: Endoscopic variceal band ligation

      Explanation:

      The correct course of action after giving terlipressin and resuscitating with IV fluids is to perform an EGD with endoscopic variceal band ligation. According to NICE: ‘Offer endoscopic variceal band ligation for the primary prevention of bleeding for people with cirrhosis who have medium to large oesophageal varices. There are serious complications of a TIPS procedure and it is not the first line treatment.

    • This question is part of the following fields:

      • Gastroenterology
      26.7
      Seconds
  • Question 11 - An 80 year old woman is admitted with a right lower lobe pneumonia....

    Correct

    • An 80 year old woman is admitted with a right lower lobe pneumonia. There is consolidation and a moderate sized pleural effusion on the same side. An ultrasound guided pleural fluid aspiration is performed. The appearance of the fluid is clear and is sent off for culture. Whilst awaiting the culture results, which one of the following is the most important factor when determining whether a chest tube should be placed?

      Your Answer: pH of the pleural fluid

      Explanation:

      In adult practice, biochemical analysis of pleural fluid plays an important part in the management of pleural effusions. Protein levels or Light’s criteria differentiate exudates from transudates, while infection is indicated by pleural acidosis associated with raised LDH and low glucose levels. In terms of treatment, the pH may even guide the need for tube drainage, suggested by pH <7.2 in an infected effusion, although the absolute protein values are of no value in determining the likelihood of spontaneous resolution or chest drain requirements. pH is therefore the most important factor.

    • This question is part of the following fields:

      • Respiratory
      13.6
      Seconds
  • Question 12 - A 64 year old woman with ankylosing spondylitis presents with cough, weight loss...

    Incorrect

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

      Your Answer: Tuberculosis

      Correct Answer: Mycobacterium avium intracellular complex

      Explanation:

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

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

      Clinical criteria are as follows:

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

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

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

    • This question is part of the following fields:

      • Respiratory
      26.2
      Seconds
  • Question 13 - A 28-year-old woman attends for review. She has a past history of a...

    Incorrect

    • A 28-year-old woman attends for review. She has a past history of a perianal abscess but nothing else of note. During the past few months she has twice presented to A&E complaining of grumbling abdominal pain. In addition, she has suffered intermittent episodes of bloody diarrhoea. Microcytic anaemia is found on blood testing and she has mild hypokalaemia. Albumin is reduced but other liver function tests are unremarkable. Barium imaging reveals a small bowel stricture with evidence of mucosal ulceration extending into the colon, interspersed with normal looking mucosa ‘skipping’. Given this clinical picture, which is the most likely diagnosis?

      Your Answer: Tropical sprue

      Correct Answer: Crohn’s disease

      Explanation:

      The correct answer based on the clinical scenario is Crohn’s disease. Associated with this disease are abscesses and fistulas in the anorectal region, skip lesions, cobble stoning, stricturing, granulomas, and crypt distortion. The other answer choices are not correct. How to rule out ulcerative colitis: it only involves ileocolorectal regions, and this is above that level. You will not see crypt distortion and cobble stoning; it is a more superficial process.

    • This question is part of the following fields:

      • Gastroenterology
      21.9
      Seconds
  • Question 14 - Which of the following physical findings is least typical on a patient with...

    Incorrect

    • Which of the following physical findings is least typical on a patient with multiple sclerosis?

      Your Answer: Weakness

      Correct Answer: Decreased tone

      Explanation:

      Attacks or exacerbations of multiple sclerosis (MS) are characterized by symptoms that reflect central nervous system (CNS) involvement, hence upper motor neuron symptoms are seen.

    • This question is part of the following fields:

      • Neurology
      19.1
      Seconds
  • Question 15 - An elderly woman is admitted to the hospital with a community-acquired pneumonia (CAP)....

    Correct

    • An elderly woman is admitted to the hospital with a community-acquired pneumonia (CAP). Her medical notes state that she developed a skin rash after taking penicillin a few years ago. She has a CURB score of 4 and adverse prognostic features. Which of the following would be an appropriate empirical antibiotic choice?

      Your Answer: Cefotaxime and erythromycin

      Explanation:

      Community-acquired pneumonia (CAP) is one of the most common infectious diseases and is an important cause of mortality and morbidity worldwide. Typical bacterial pathogens that cause CAP include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
      The CURB-65 is used as a means of deciding the action that is needed to be taken for that patient.
      Score 3-5: Requires hospitalization with consideration as to whether they need to be in the intensive care unit

      Recent studies have suggested that the use of a beta-lactam alone may be noninferior to a beta-lactam/macrolide combination or fluoroquinolone therapy in hospitalized patients.

      Therapy in ICU patients includes the following:
      – Beta-lactam (ceftriaxone, cefotaxime, or ampicillin/sulbactam) plus either a macrolide or respiratory fluoroquinolone
      – For patients with penicillin allergy, a respiratory fluoroquinolone and aztreonam

      Therefore the appropriate treatment would be Cefotaxime and erythromycin.

    • This question is part of the following fields:

      • Respiratory
      31.1
      Seconds
  • Question 16 - You are reviewing a 70-year-old gentleman who has been suffering from multiple myeloma...

    Correct

    • You are reviewing a 70-year-old gentleman who has been suffering from multiple myeloma for the past 3 years. He presents with lethargy, muscle aches and pain in his lower back.   Arterial blood sampling reveals a metabolic acidosis. Serum potassium is 3.1 mmol/l (3.5–4.9), and urine pH is 5.1 (> 5.3).   What is the most likely diagnosis?

      Your Answer: Renal tubular acidosis-type II

      Explanation:

      This case is most likely RTA type II, due to decreased proximal bicarbonate reabsorption, which leads to metabolic acidosis, hypokalaemia, hyperchloremia, and <6 urine pH .

    • This question is part of the following fields:

      • Nephrology
      20.6
      Seconds
  • Question 17 - A prescription for Olanzapine is written for a 28 year old lady with...

    Incorrect

    • A prescription for Olanzapine is written for a 28 year old lady with a history of schizophrenia. Which adverse effect is she most likely to experience?

      Your Answer: Parkinsonism

      Correct Answer: Weight gain

      Explanation:

      Weight gain is an extremely common (5-40%) adverse effect of atypical antipsychotics such as olanzapine (dose dependent). Olanzapine causes orthostatic hypotension ≥20% of reported cases. Parkinsonism reactions occurs in 4% of people.

    • This question is part of the following fields:

      • Psychiatry
      6.4
      Seconds
  • Question 18 - A 20-year-old woman presents to casualty with flank pain and a 48 hour...

    Incorrect

    • A 20-year-old woman presents to casualty with flank pain and a 48 hour history of dysuria. Her past medical history includes polycystic ovarian syndrome. She is not in a steady relationship at present. There is haematuria and proteinuria on urine dipstick testing. Examination reveals a pyrexia of 38.1 °C and flank pain. What diagnosis fits best with this clinical picture?

      Your Answer: Pelvic inflammatory disease

      Correct Answer: Pyelonephritis

      Explanation:

      The patient presents with flank pain and fever with haematuria and proteinuria associated with a social history of not being in a steady relationship. This patient is a young presumably sexually active female, so the diagnosis is most likely pyelonephritis which has an increased incidence in young sexually active women or men of >50 years of age.

    • This question is part of the following fields:

      • Nephrology
      15
      Seconds
  • Question 19 - A 42 year old male arrives at the clinic due to cough and...

    Correct

    • A 42 year old male arrives at the clinic due to cough and haemoptysis. Examination shows nasal mucosal ulceration. The doctor suspects Wegener's granulomatosis. Which anatomical area would be most commonly involved in this condition?

      Your Answer: Lungs

      Explanation:

      Granulomatosis with polyangiitis (GPA, previously known as Wegener’s granulomatosis) is a systemic vasculitis that affects both small and medium-sized vessels. Patients typically initially suffer from a limited form that may consist of constitutional symptoms and localized manifestations such as chronic sinusitis, rhinitis, otitis media, ocular conditions. In later stages, more serious manifestations may arise, including pulmonary complications and glomerulonephritis, although the skin, eyes, and heart may also be involved but these lesions are less common.
      Diagnosis is based on laboratory testing (positive for PR3-ANCA/c-ANCA), imaging, and biopsy of affected organs, which demonstrate necrotizing granulomatous inflammation. GPA is treated with immunosuppressive drugs, typically consisting of glucocorticoids combined with methotrexate, cyclophosphamide, or rituximab. Relapses are common and the following systems are affected: Lower respiratory tract (95% of cases), renal involvement (80% of cases), skin lesions (45% of cases), ocular involvement (45% of cases) and cardiac involvement (33% of cases).

    • This question is part of the following fields:

      • Rheumatology
      10.3
      Seconds
  • Question 20 - A girl suffered full thickness circumferential burn to her right arm. What is...

    Correct

    • A girl suffered full thickness circumferential burn to her right arm. What is best step in management?

      Your Answer: Escharotomy

      Explanation:

      An escharotomy is a surgical procedure used to treat full-thickness (third-degree) circumferential burns. In full-thickness burns, both the epidermis and the dermis are destroyed along with sensory nerves in the dermis. The tough leathery tissue remaining after a full-thickness burn has been termed eschar.

    • This question is part of the following fields:

      • Dermatology
      18.7
      Seconds
  • Question 21 - A 20-year-old gentleman presents to the A&E department complaining of a sudden-onset occipital...

    Correct

    • A 20-year-old gentleman presents to the A&E department complaining of a sudden-onset occipital headache associated with vomiting. His symptoms started 2 hours previously and are continuing. He has a previous history of infrequent migraine without aura, which also causes nausea but not vomiting. He rated his current headache as much more severe than his usual migraine. Examination is unremarkable. In particular, there is no neck stiffness or photophobia. Which of the following management options would be the most appropriate?

      Your Answer: CT brain scan, followed by lumbar puncture if CT normal

      Explanation:

      The patient presented with sudden-onset headache that is more painful than his usual migraine attacks. This gives a high suspicion of subarachnoid haemorrhage; thus, a CT brain scan should be ordered first to rule this out. However, a normal CT scan is apparent in 30% of patients with subarachnoid haemorrhage and should be referred for lumbar puncture to look for red blood cells.

    • This question is part of the following fields:

      • Neurology
      59.1
      Seconds
  • Question 22 - A 78 year old woman presents to the clinic complaining of left sided...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Rheumatology
      16.7
      Seconds
  • Question 23 - A 25-year-old woman with Charcot-Marie-Tooth disease (type 1) asks how likely it is...

    Correct

    • A 25-year-old woman with Charcot-Marie-Tooth disease (type 1) asks how likely it is that any future children will have the disease. What is the most accurate answer?

      Your Answer: 50%

      Explanation:

      Because Charcot-Marie-Tooth disease (type 1) is an autosomal dominant condition; therefore, there is a 50% chance that the children of this patient will be affected.

    • This question is part of the following fields:

      • Neurology
      8.2
      Seconds
  • Question 24 - A health professional plans to visit Brazil but has recently come to know...

    Incorrect

    • A health professional plans to visit Brazil but has recently come to know that there is epidemic of West Nile virus there. Regarding the virus, which of the following is true?

      Your Answer: Is a member of the picornavirus family

      Correct Answer:

      Explanation:

      West Nile virus is an RNA virus transmitted by the Culex species of mosquitoes. It is mostly prevalent in South America, Africa and some parts of Europe. Clinically it presents with high grade fever, headache, abdominal pain, anorexia and a morbilliform rash over the body. It can also lead to meningitis, encephalitis and flaccid paralysis by affecting the anterior horn cells, a process suggesting similarity to poliomyelitis. It can be fatal if not treated abruptly. Studies suggest that it can be transferred from mother to offspring. New-borns may present with encephalitis, chorioretinitis and wide spread brain damage. Patients suffering from West Nile virus can be effectively treated with interferon, IV immunoglobulin and Ribavirin.

    • This question is part of the following fields:

      • Infectious Diseases
      14
      Seconds
  • Question 25 - A 62-year-old man presents with haematuria. Cystoscopy is carried out which reveals transitional...

    Incorrect

    • A 62-year-old man presents with haematuria. Cystoscopy is carried out which reveals transitional cell carcinoma of the bladder. Occupational exposure to which of the following is a recognised risk factor for bladder cancer?

      Your Answer: Strongyloides stercoralis

      Correct Answer: Aniline dye

      Explanation:

      The risk factors for bladder cancer are:

      1. Smoking
      2. Exposure to aniline dyes in the printing and textile industry
      3. Exposure to rubber manufacturing
      4. Cyclophosphamides
      5. Schistosomiasis.

    • This question is part of the following fields:

      • Haematology & Oncology
      9.1
      Seconds
  • Question 26 - A 65 yr. old previously well man was referred due to an abnormal...

    Incorrect

    • 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: Discharge him from the clinic

      Correct 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
      48.6
      Seconds
  • Question 27 - A 17-year-old man presents with fever and extensive pre-auricular swelling on the right...

    Correct

    • A 17-year-old man presents with fever and extensive pre-auricular swelling on the right side of his face. However, tenderness is present bilaterally. He also complains of acute pain and otalgia on the right aspect of the face. What is the most likely diagnosis?

      Your Answer: Mumps

      Explanation:

      Mumps presents with a prodromal phase of general malaise and fever. On examination there is usually painful parotid swelling which has high chances of becoming bilateral. In OM with effusion there are no signs of infection and the only symptom is usually hearing loss. Acute otitis externa produces otalgia as well as ear discharge and itching. Acute OM produces otalgia and specific findings upon otoscopy. In acute mastoiditis the patient experiences ear discharge, otalgia, headache, hearing loss and other general signs of inflammation.

    • This question is part of the following fields:

      • Infectious Diseases
      35.6
      Seconds
  • Question 28 - Out of the following, which tumour cells are found in patients with Hodgkin...

    Correct

    • Out of the following, which tumour cells are found in patients with Hodgkin disease?

      Your Answer: Reed-Sternberg cells

      Explanation:

      The diagnosis of Hodgkin disease requires the identification of Reed-Sternberg cells in a characteristic cellular background. The normal cell of origin for the Reed-Sternberg cells remains unclear, with the predominance of evidence indicating a B or T lymphocyte.

    • This question is part of the following fields:

      • Haematology & Oncology
      8.7
      Seconds
  • Question 29 - A 43-year-old right-handed migraineur is admitted to hospital having developed paraesthesia affecting her...

    Incorrect

    • A 43-year-old right-handed migraineur is admitted to hospital having developed paraesthesia affecting her left arm. This came on suddenly during a migrainous attack while out shopping. The paraesthesia appeared to effect the entire left arm and in the last few hours, has spread to involve the left side of the face. She had had a similar episode several months ago whereby she developed some right-sided leg and arm weakness while at work. The weakness lasted several minutes and subsequently abated. At the time, she was also having one of her migraines. She has a long-standing history of migraines, which typically start with a prolonged aura and fortification spectra. Other then migraines, for which she has been taking pizotifen, she has no other past medical history. Her sister also suffers from migraines, and her mother has a history of dementia in her 50s. She is a non-smoker and drinks minimal alcohol. On examination she was orientated but apathetic. Her blood pressure was 130/65 mmHg, pulse 62/min, and temperature 36.2ºC. There were no carotid bruits and heart sounds were entirely normal. There was reduced sensation to all modalities over the left side of the face extending to the vertex and the entire left arm. Tone and reflexes appeared intact; however, handgrip was reduced on the left due to numbness. The lower limb appeared entirely normal. Magnetic resonance (MR) scan showed bilateral, multifocal, T2/FLAIR (fluid attenuated inversion recovery ) hyperintensities in the deep white matter. MR Spinal cord was normal. What is the diagnosis?

      Your Answer: Multiple sclerosis

      Correct Answer: CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy)

      Explanation:

      CADASIL is the most common form of hereditary stroke disorder. This case has a strong history of migraine with aura with stroke-like episodes, characteristic of CADASIL. Additionally, there is positive family history of migraine and early dementia but no other vascular risk factors like hypertension, diabetes, or hypercholesterolaemia, which all confirm the suspicion of CADASIL, an arteriopathy where there is thickening of the smooth muscle cells in the blood vessels.

    • This question is part of the following fields:

      • Neurology
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      Seconds
  • Question 30 - A 41-year-old female is referred to medical assessment unit by her physician for...

    Incorrect

    • A 41-year-old female is referred to medical assessment unit by her physician for querying thrombotic thrombocytopenic purpura (TTP) after she presented with a temperature of 38.9C. Her subsequent urea and electrolytes showed deteriorating renal function with a creatinine 3 times greater than her baseline. What is the underlying pathophysiology of TTP?

      Your Answer:

      Correct Answer: Failure to cleave von Willebrand factor normally

      Explanation:

      Thrombotic thrombocytopenic purpura (TTP) is characterised by the von Willebrand factor (vWF) microthrombi within the vessels of multiple organs. In this condition, the ADAMTS13 metalloprotease enzyme which is responsible for the breakdown of vWF multimer, is deficient, causing its build-up and leading to platelet clots that then decreases the circulating platelets, leading to bleeding in the patient.

    • This question is part of the following fields:

      • Nephrology
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SESSION STATS - PERFORMANCE PER SPECIALTY

Endocrinology (0/2) 0%
Respiratory (3/5) 60%
Rheumatology (2/3) 67%
Clinical Sciences (2/2) 100%
Haematology & Oncology (1/3) 33%
Nephrology (1/3) 33%
Gastroenterology (1/2) 50%
Neurology (2/4) 50%
Psychiatry (0/1) 0%
Dermatology (1/1) 100%
Infectious Diseases (1/2) 50%
Cardiology (0/1) 0%
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