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  • Question 1 - Which of the following is consistent with a diagnosis of insulinoma? ...

    Correct

    • Which of the following is consistent with a diagnosis of insulinoma?

      Your Answer: Low fasting glucose, high insulin, high C peptide

      Explanation:

      Insulinoma is associated with LOW fasting glucose, HIGH insulin level, and HIGH C peptide. Insulin-abuse or overdose will cause HGH insulin levels and a LOW C peptide. If the C peptide is low, be suspicious.

    • This question is part of the following fields:

      • Gastroenterology
      7.2
      Seconds
  • Question 2 - A 47 year old woman presents with joint pains and a history of...

    Incorrect

    • A 47 year old woman presents with joint pains and a history of recurrent infections over the past few months. Labs reveal a positive rheumatoid factor and low white cell count. Given the likely diagnosis, which of the following features would be present in her case?

      Your Answer: Flexural surface rheumatoid nodules

      Correct Answer: Splenomegaly

      Explanation:

      Felty syndrome is a severe subtype of seropositive Rheumatoid arthritis. Clinical triad consists of arthritis, splenomegaly, and neutropenia (leads to an increased risk of recurrent bacterial infections). Other symptoms include skin ulcers of the lower limbs (indicating vasculitis), hepatomegaly, fever, and chest pain (indicating pleuritis or pericarditis). It is associated with increased risk of developing non-Hodgkin lymphoma.

    • This question is part of the following fields:

      • Rheumatology
      13.3
      Seconds
  • Question 3 - A 50-year-old woman is referred to the outpatient clinic with a 6-month history...

    Correct

    • 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: 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
      31.1
      Seconds
  • Question 4 - A study is developed to compare two chemotherapy schemas for individuals with small...

    Incorrect

    • A study is developed to compare two chemotherapy schemas for individuals with small cell lung cancer. Which of the following would you choose to compare survival time with in this particular study?

      Your Answer: Absolute risk reduction

      Correct Answer: Hazard ratio

      Explanation:

      The hazard ratio describes the relative risk of the complication based on comparison of event rates.

      Hazard ratios have also been used to describe the outcome of therapeutic trials where the question is to what extent treatment can shorten the duration of the illness. However, the hazard ratio, a type of relative risk, does not always accurately portray the degree of abbreviation of the illness that occurred. In these circumstances, time-based parameters available from the time-to-event curve, such as the ratio of the median times of the placebo and drug groups, should be used to describe the magnitude of the benefit to the patient. The difference between hazard-based and time-based measures is analogous to the odds of winning a race and the margin of victory. The hazard ratio is the odds of a patient’s healing faster under treatment but does not convey any information about how much faster this event may occur.

    • This question is part of the following fields:

      • Clinical Sciences
      12.6
      Seconds
  • Question 5 - Which one of the following statements regarding nitric oxide is incorrect? ...

    Correct

    • Which one of the following statements regarding nitric oxide is incorrect?

      Your Answer: Promotes platelet aggregation

      Explanation:

      Nitric oxide, known as an endothelium-derived relaxing factor (EDRF), is biosynthesized endogenously from L-arginine, oxygen, and NADPH by various nitric oxide synthase (NOS) enzymes and is a signaling molecule in many physiological and pathological processes in humans.
      One of the main enzymatic targets of nitric oxide is guanylyl cyclase. The binding of nitric oxide to the haem region of the enzyme leads to activation, in the presence of iron.

    • This question is part of the following fields:

      • Clinical Sciences
      14.6
      Seconds
  • Question 6 - A 30-year-old female presented in the ophthalmology ward complaining of blurry vision for...

    Correct

    • A 30-year-old female presented in the ophthalmology ward complaining of blurry vision for 4 days. Fundoscopy of both eyes revealed cotton wool spots in both the retinas. What is the most likely cause of this condition?

      Your Answer: CMV infection

      Explanation:

      Fundoscopy findings of cotton wool spots and retinal tears, accompanied by a history of blurred vision, are characteristic of retinitis. Cytomegalovirus is known to cause retinitis.

    • This question is part of the following fields:

      • Ophthalmology
      23.3
      Seconds
  • Question 7 - An 18 year old boy from Middle East presented with a 1 month...

    Incorrect

    • An 18 year old boy from Middle East presented with a 1 month history of a yellowish, crusted plaque over his scalp, along with some scarring alopecia. What will the likely diagnosis be?

      Your Answer: Cradle Cap

      Correct Answer: Favus

      Explanation:

      Favus is a fungal infection of the scalp, resulting in the formation of a yellowish crusted plaque over the scalp and leads to scar formation with alopecia. Tinea capitus is a fungal infection of the scalp resulting in scaling and non scarring hair loss. Folliculitis presents with multiple perifollicular papules which can be caused by both bacteria and fungi. Cradle cap usually affects infants where the whole scalp is involved. It can lead to hair loss and responds to topical antifungals and keratolytics.

    • This question is part of the following fields:

      • Dermatology
      9.5
      Seconds
  • Question 8 - A 48-year-old patient with type 1 diabetes and chronic kidney disease attends for...

    Correct

    • A 48-year-old patient with type 1 diabetes and chronic kidney disease attends for review. His blood tests show: Haemoglobin 11.2 g/dl (13.0 – 18.0 g/dL) MCV 87 fl (80 – 96 fL) Sodium 133 mmol/l (137 – 144 mmol/L) Potassium 4.3 mmol/l (3.5 – 4.9 mmol/L) Urea 19.1 mmol/l (2.5 – 7.5 mmol/L) Creatinine 267 μmol/l (60 – 110 μmol/L) Ferritin 150 μg/l (15 – 300 μg/L) C reactive protein <5 mg/l (< 10 mg/L)   What is the most appropriate management of his anaemia?

      Your Answer: Monitor haemoglobin, no treatment required at present

      Explanation:

      Because the patient has chronic kidney disease, we need to consider the associated adverse effects of trying to maintain normal haemoglobin levels (14-18g/dl in this patient) and instead only instigate therapy when the level falls below 11 g/dl. Thus, in this case we should just monitor the haemoglobin levels and not initiate therapy just yet.

    • This question is part of the following fields:

      • Nephrology
      25.4
      Seconds
  • Question 9 - A 60-year-old man with a history of recent thyrotoxicosis underwent major surgery a...

    Incorrect

    • A 60-year-old man with a history of recent thyrotoxicosis underwent major surgery a week ago. He now presents with altered mental status, tachycardia, high-grade fever, vomiting and cardiac failure. A diagnosis of thyroid storm (crisis) is made. What is the most important next step in management?

      Your Answer: Potassium iodide should be given immediately before propylthiouracil

      Correct Answer: Transfer the patient to ITU

      Explanation:

      Thyroid storm, also referred to as thyrotoxic crisis, is an acute, life-threatening, hypermetabolic state induced by excessive release of thyroid hormones (THs) in individuals with thyrotoxicosis.
      Patients with thyroid storm should be treated in an ICU setting for close monitoring of vital signs and for access to invasive monitoring and inotropic support, if necessary.
      – Supportive measures
      If needed, immediately provide supplemental oxygen, ventilatory support, and intravenous fluids. Dextrose solutions are the preferred intravenous fluids to cope with continuously high metabolic demand.
      – Correct electrolyte abnormalities.
      – Treat cardiac arrhythmia, if necessary.
      – Aggressively control hyperthermia by applying ice packs and cooling blankets and by administering acetaminophen (15 mg/kg orally or rectally every 4 hours).
      – Antiadrenergic drugs.
      – Thionamides: Correct the hyperthyroid state. Administer antithyroid medications to block further synthesis of thyroid hormones (THs).
      High-dose propylthiouracil (PTU) or methimazole may be used for treatment of thyroid storm.
      – Administer glucocorticoids to decrease peripheral conversion of T4 to T3. This may also be useful in preventing relative adrenal insufficiency due to hyperthyroidism and improving vasomotor symptoms.
      – Bile acid sequestrants prevent reabsorption of free THs in the gut (released from conjugated TH metabolites secreted into bile through the enterohepatic circulation).
      – Treat the underlying condition.

    • This question is part of the following fields:

      • Endocrinology
      24.8
      Seconds
  • Question 10 - A 20-year-old man presents with a history of sticky greenish discharge, accompanied by...

    Correct

    • A 20-year-old man presents with a history of sticky greenish discharge, accompanied by redness of the eyes, and difficulty opening his eyes in the morning. What is the single most likely cause of these symptoms?

      Your Answer: Conjunctivitis

      Explanation:

      Redness of the eyes can present in all of the conditions. However, the green sticky discharge that causes the eyelids to stick together overnight is characteristic of bacterial conjunctivitis. Bacterial conjunctivitis is an inflammatory condition of the conjunctiva in which bacteria commonly Staphylococcus Aureus invade the conjunctiva. The person experiences a foreign body feeling in the eye and mucopurulent or purulent discharge.

    • This question is part of the following fields:

      • Ophthalmology
      8.9
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Gastroenterology (1/1) 100%
Rheumatology (0/1) 0%
Endocrinology (1/2) 50%
Clinical Sciences (1/2) 50%
Ophthalmology (2/2) 100%
Dermatology (0/1) 0%
Nephrology (1/1) 100%
Passmed