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  • Question 1 - A 40-year-old man presents with recurrent headaches, 2-3 times a day, associated with...

    Incorrect

    • A 40-year-old man presents with recurrent headaches, 2-3 times a day, associated with sweating and palpitations. His blood pressure during the attacks is around 220/120 mmHg. Given the likely diagnosis, what is the next appropriate investigation?

      Your Answer: 24 hour urinary collection of vanillylmandelic acid

      Correct Answer: 24 hour urinary collection of metanephrines

      Explanation:

      Classically, pheochromocytoma manifests with the following 4 characteristics:
      – Headaches
      – Palpitations
      – Sweating
      – Severe hypertension

      The Endocrine Society, the American Association for Clinical Chemistry, and the European Society of Endocrinology have released clinical practice guidelines for the diagnosis and management of pheochromocytoma.
      Biochemical testing via measurement of plasma free metanephrines or urinary fractionated metanephrines should be performed in patients suspected of having pheochromocytoma.

      Catecholamines produced by pheochromocytomas are metabolized within chromaffin cells. Norepinephrine is metabolized to normetanephrine and epinephrine is metabolized to metanephrine. Because this process occurs within the tumour, independently of catecholamine release, pheochromocytomas are best diagnosed by measurement of these metabolites rather than by measurement of the parent catecholamines.

    • This question is part of the following fields:

      • Endocrinology
      9.2
      Seconds
  • Question 2 - A 20-year-old student nurse was admitted after her third collapse in recent months....

    Incorrect

    • A 20-year-old student nurse was admitted after her third collapse in recent months. She was noted to have a blood sugar of 0.9 mmol/l on finger-prick testing and responded well to intravenous glucose therapy. Venous blood taken at the same showed a markedly raised insulin level, but her C-peptide levels were normal. What diagnosis fits best with this clinical picture?

      Your Answer: Insulinoma

      Correct Answer: Self-administration of a short-acting insulin

      Explanation:

      The patient has hyperinsulinemia and hypoglycaemia, but her C-peptide levels are normal. This is strongly suggestive of the fact that she is self-administering insulin.
      In Insulinoma, common diagnostic criteria include:
      – blood glucose level < 50 mg/dl with hypoglycaemic symptoms,
      – relief of symptoms after eating
      – absence of sulfonylurea on plasma assays.
      The classic diagnostic criteria include the demonstration of the following during a supervised fast:
      Increased plasma insulin level
      Increased C peptide level
      Increased proinsulin level
      However, the patient has normal C-peptide levels.
      In type-1 diabetes mellitus, insulin and C-peptide levels are low.

    • This question is part of the following fields:

      • Endocrinology
      44.8
      Seconds
  • Question 3 - A 48 yr. old male presented with exertional angina for 2 weeks. He...

    Correct

    • A 48 yr. old male presented with exertional angina for 2 weeks. He has no significant past medical history or cardiac risk factors except a total cholesterol of 5.8 mmol/L. He has been already started on aspirin. Which of the following is the most suitable drug combination for him?

      Your Answer: B-blocker and statin

      Explanation:

      Beta blockers and calcium channel blockers have proven prognostic benefits. Nitrates don’t have any proven prognostic benefits. A statin is indicated for a patient with angina and cholesterol level of 5.5 to 8.5 to prevent risk of myocardial infarction. So the preferred combination from the given answers is beta blocker + statin.

    • This question is part of the following fields:

      • Cardiology
      25.5
      Seconds
  • Question 4 - What is the mechanism of action of carbimazole? ...

    Incorrect

    • What is the mechanism of action of carbimazole?

      Your Answer: Conversion to methimazole, which blocks the TSH receptor

      Correct Answer: Inhibition of the iodination of tyrosine

      Explanation:

      Carbimazole is used to treat hyperthyroidism. Carbimazole is a pro-drug as after absorption it is converted to the active form, methimazole. Methimazole prevents thyroid peroxidase enzyme from coupling and iodinating the tyrosine residues on thyroglobulin, hence reducing the production of the thyroid hormones T3 and T4 (thyroxine).

    • This question is part of the following fields:

      • Pharmacology
      8.4
      Seconds
  • Question 5 - A patient has been diagnosed with multi-drug resistant tuberculosis and is currently bring...

    Correct

    • A patient has been diagnosed with multi-drug resistant tuberculosis and is currently bring treated with rifampicin, isoniazid, and pyrazinamide. He is commenced on streptomycin. Which among the following is the most likely neurological side-effect of streptomycin?

      Your Answer: Vestibular damage

      Explanation:

      Vestibular damage is a neurological side effect of streptomycin.

      Streptomycin is an aminoglycoside bactericidal antibiotic. It is used in the treatment of tularaemia and resistant mycobacterial infections.
      The most common neurological side-effect is vestibular damage leading to vertigo and vomiting.
      Cochlear damage is less frequent and results in deafness.
      Other side-effects include rashes, angioneurotic oedema, and nephrotoxicity.

    • This question is part of the following fields:

      • Pharmacology
      9.7
      Seconds
  • Question 6 - A 50-year-old male presents to the ER allegedly claiming that he consumed a...

    Incorrect

    • A 50-year-old male presents to the ER allegedly claiming that he consumed a bottle of antifreeze. Which of the following symptoms is least likely to be associated with this kind of poisoning?

      Your Answer: Hypertension

      Correct Answer: Loss of vision

      Explanation:

      Loss of vision after consumption of antifreeze is a characteristic presentation of methanol poisoning.

      Pathophysiology of methanol toxicity:
      When ingested, methanol is absorbed rapidly via the gastrointestinal tract in less than 10 minutes. Methanol is not protein-bound and is absorbed directly into the total body water compartment.
      Metabolism occurs mainly in the liver through serial oxidation via alcohol dehydrogenase and aldehyde dehydrogenase but begins with alcohol dehydrogenase present in the gastric mucosa.
      Alcohol dehydrogenase oxidizes methanol to formaldehyde, and aldehyde dehydrogenase subsequently oxidizes formaldehyde to formic acid.
      Formic acid is the primary toxic metabolite that accounts for the associated anion gap metabolic acidosis and end-organ damage.

      Clinical presentation:
      Patients who present within the first 12 to 24 hours following ingestion may appear normal, and this is described as the latent period.
      Nausea, vomiting, and abdominal pain subsequently ensue, followed by CNS depression and hyperventilation due to metabolic acidosis.
      Ocular symptoms associated with retinal toxicity are often evident in the form of blurry vision, decreased visual acuity, photophobia, and “halo vision.”

      Treatment:
      Treatment options for methanol toxicity include supportive care, fomepizole (Antizole, 4-Methylpyrazole or 4MP), ethanol, dialysis, and folate.

    • This question is part of the following fields:

      • Pharmacology
      24.8
      Seconds
  • Question 7 - Intracellular proteins tagged with mannose-6-phosphate are destined to which of the following organelles?...

    Incorrect

    • Intracellular proteins tagged with mannose-6-phosphate are destined to which of the following organelles?

      Your Answer: Smooth endoplasmic reticulum

      Correct Answer: Lysosome

      Explanation:

      Lysosomal hydrolases are synthesized in the rough endoplasmic reticulum and specifically transported through the Golgi apparatus to the trans-Golgi network, from which transport vesicles bud to deliver them to the endosomal/lysosomal compartment. The explanation of how the lysosomal enzymes are accurately recognized and selected over many other proteins in the trans-Golgi network relies on them being tagged with a unique marker: the mannose-6-phosphate (M6P) group, which is added exclusively to the N-linked oligosaccharides of lysosomal soluble hydrolases, as they pass through the cis-Golgi network. Generation of the M6P recognition marker depends on a reaction involving two different enzymes: UDP-N-acetylglucosamine 1-phosphotransferase and α-N-acetylglucosamine-1-phosphodiester α-N-acetylglucosaminidase.

    • This question is part of the following fields:

      • Clinical Sciences
      8.5
      Seconds
  • Question 8 - Which one of the following statements regarding mitochondrial inheritance is true? ...

    Incorrect

    • Which one of the following statements regarding mitochondrial inheritance is true?

      Your Answer: Most cases of spinocerebellar ataxia are caused by defects in mitochondrial DNA

      Correct Answer: Poor genotype:phenotype correlation

      Explanation:

      The human cell has two type of DNA: Nuclear DNA and Mitochondrial DNA (MtDNA). A MtDNA copy is passed down entirely unchanged, through the maternal line. Males cannot pass their MtDNA to their offspring although they inherit a copy of it from their mother. There is poor genotype:phenotype correlation. Within a tissue or cell there can be different mitochondrial populations (this is known as heteroplasmy).
      Examples of mitochondrial diseases include:
      – Leber’s optic atrophy
      – MELAS syndrome (mitochondrial encephalomyopathy lactic acidosis and stroke-like episodes)
      – MERRF syndrome (myoclonus epilepsy with ragged-red fibres)
      – Kearns-Sayre syndrome (more severe syndromic variant of chronic progressive external ophthalmoplegia, onset in patients < 20 years old)

    • This question is part of the following fields:

      • Clinical Sciences
      10.3
      Seconds
  • Question 9 - A 29-year-old physiotherapist with a history of bilateral vitreous haemorrhage is referred due...

    Incorrect

    • A 29-year-old physiotherapist with a history of bilateral vitreous haemorrhage is referred due to progressive ataxia. Which of the following is the most likely diagnosis?

      Your Answer: Neurofibromatosis type II

      Correct Answer: Von Hippel-Lindau syndrome

      Explanation:

      Retinal and cerebellar haemangiomas are key features of Von Hippel-Lindau syndrome. Retinal haemangiomas are bilateral in 25% of patients and may lead to vitreous haemorrhage. Von Hippel-Lindau (VHL) syndrome is an autosomal dominant condition predisposing to neoplasia. It is due to an abnormality in the VHL gene located on short arm of chromosome 3.

    • This question is part of the following fields:

      • Neurology
      11.6
      Seconds
  • Question 10 - A 45 yr. old male was discharged recently after treatment of bleeding peptic...

    Correct

    • A 45 yr. old male was discharged recently after treatment of bleeding peptic ulcers. 3 days after discharge he was readmitted complaining of acute severe chest pain for the past 1 hour. His ECG showed an acute ST elevation myocardial infarction. His FBC, blood urea, serum electrolytes and serum creatinine were within normal ranges. Faecal occult blood was negative. Which of the following is the most appropriate management for this patient?

      Your Answer: Primary angioplasty

      Explanation:

      The patient has a recent history of bleeding peptic ulcer disease, which is an absolute contraindication for thrombolysis. So he should be offered primary angioplasty.

    • This question is part of the following fields:

      • Cardiology
      1.3
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Endocrinology (0/2) 0%
Cardiology (2/2) 100%
Pharmacology (1/3) 33%
Clinical Sciences (0/2) 0%
Neurology (0/1) 0%
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