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  • Question 1 - Which of the following would be the most appropriate treatment (leaving out the...

    Incorrect

    • Which of the following would be the most appropriate treatment (leaving out the current NICE guidelines) for a 29 year old man with erythrodermic psoriasis and arthritis mutilans involving several digits of both hands?

      Your Answer: Methotrexate

      Correct Answer: Etanercept

      Explanation:

      TNF-alpha inhibitors are known to ameliorate the symptoms and disease activity of Arthritis mutilans (a rare and severe form of psoriatic arthritis), by disabling the cytokines that are involved in inflammation and joint destruction. From the mentioned choices, this would be the most effective option. Methotrexate is the most commonly used DMARD, followed by sulfasalazine used in mild to moderate forms of psoriatic arthritis but has not shown much efficacy in arthritis mutilans. Phototherapy, narrowband UVB light therapy can be very effective in clearing skin lesions.

    • This question is part of the following fields:

      • Rheumatology
      17.6
      Seconds
  • Question 2 - A 67 year-old attorney presents with a 2 month history of tremors affecting...

    Correct

    • A 67 year-old attorney presents with a 2 month history of tremors affecting his left arm. He suffers from depressive psychosis for the last 10 years, for which he has been receiving intermittent chlorpromazine and amitriptyline but has not been on any therapy for the last 4 months. He describes that his two brothers also had tremors. Upon examination, he has a resting tremor of his left hand with cogwheel rigidity of that arm and mild generalized bradykinesia. Which of the following is the most likely diagnosis?

      Your Answer: Idiopathic Parkinson’s disease

      Explanation:

      The most likely diagnosis is idiopathic Parkinson’s disease because of the unilateral presentation. In addition, cogwheel rigidity is a classic presenting symptom. Neuroleptic-induced parkinsonism is usually bilateral and symmetrical. Essential tremors do not cause rest tremors.

    • This question is part of the following fields:

      • Neurology
      20
      Seconds
  • Question 3 - Which of the following statements describe the mechanism of fibrates most accurately? ...

    Incorrect

    • Which of the following statements describe the mechanism of fibrates most accurately?

      Your Answer: Increases peroxisomal beta-oxidation of fatty acids

      Correct Answer: Increased lipoprotein lipase activity via PPAR-alpha

      Explanation:

      The main mechanism of fibrate drugs is activation of gene transcription factors known as PPARs, particularly PPAR-α, which regulate the expression of genes that control lipoprotein metabolism. There are several consequences of PPAR-α activation, which reduce circulating LDL cholesterol and triglycerides and increase HDL cholesterol.

    • This question is part of the following fields:

      • Cardiology
      39.1
      Seconds
  • Question 4 - Which type of lung cancer is most commonly linked to cavitating lesions? ...

    Incorrect

    • Which type of lung cancer is most commonly linked to cavitating lesions?

      Your Answer: Small cell

      Correct Answer: Squamous cell

      Explanation:

      Squamous-cell carcinoma is the most common histological type of lung cancer to cavitate (82% of cavitary primary lung cancer), followed by adenocarcinoma and large cell carcinoma. Multiple cavitary lesions in primary lung cancer are rare, however, multifocal bronchoalveolar cell carcinoma can occasionally have multiple cavitary lesions. Small cell carcinoma is not known to cavitate.

    • This question is part of the following fields:

      • Respiratory
      5.9
      Seconds
  • Question 5 - A homeless woman presented with a cough and fever for the last 3...

    Incorrect

    • A homeless woman presented with a cough and fever for the last 3 months. She also complained of night sweats and weight loss. Her CXR showed lung opacities. What is the next appropriate step for this patient?

      Your Answer: Bronchoscopy

      Correct Answer: Acid fast bacilli

      Explanation:

      History and CXR are suggestive of tuberculosis. Acid fast bacilli should be seen on microscopy to confirm the diagnosis.

    • This question is part of the following fields:

      • Infectious Diseases
      18.7
      Seconds
  • Question 6 - A 42 year old female presents with morning stiffness that usually takes an...

    Incorrect

    • A 42 year old female presents with morning stiffness that usually takes an hour to settle and a one year history of intermittent pain and swelling of the small joints of her hands. Examination reveals symmetric soft tissue swelling over the PIP and MCP joints and rheumatoid nodules on the elbows. There is also an effusion of both wrists. Lab results are positive for rheumatoid factor. X-ray of the wrists and hands shows erosions and bony decalcification. NSAIDs are started and the patient is referred to a rheumatologist for consideration of DMARD. Previous history is significant for TB. Which of the following should be avoided?

      Your Answer: Methotrexate

      Correct Answer: Infliximab

      Explanation:

      Anti-TNF-α therapy is effective for patients with arthritis but it can oftentimes lead to the reactivation of latent TB. Hence it should be used with great caution in patients with a past history of TB or current infection.

    • This question is part of the following fields:

      • Rheumatology
      10.5
      Seconds
  • Question 7 - Where is the site of action of spironolactone? ...

    Incorrect

    • Where is the site of action of spironolactone?

      Your Answer: Ascending loop of Henle

      Correct Answer: Distal convoluted tubule

      Explanation:

      Spironolactone is an aldosterone antagonist which acts in the distal convoluted tubule. It is a potassium-sparing diuretic that prevents the body from absorbing too much salt and keeps the potassium levels from getting too low. Spironolactone is used to treat heart failure, high blood pressure (hypertension), or hypokalaemia (low potassium levels in the blood).

    • This question is part of the following fields:

      • Pharmacology
      4.2
      Seconds
  • Question 8 - 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
      5.7
      Seconds
  • Question 9 - Which one of the following paraneoplastic features is less likely to be seen...

    Incorrect

    • Which one of the following paraneoplastic features is less likely to be seen in patients with squamous cell lung cancer?

      Your Answer: Hyperthyroidism

      Correct Answer: Lambert-Eaton syndrome

      Explanation:

      Lambert-Eaton myasthenic syndrome (LEMS) is a rare presynaptic disorder of neuromuscular transmission in which release of acetylcholine (ACh) is impaired, causing a unique set of clinical characteristics, which include proximal muscle weakness, depressed tendon reflexes, post-tetanic potentiation, and autonomic changes.

      In 40% of patients with LEMS, cancer is present when the weakness begins or is found later. This is usually a small cell lung cancer (SCLC). However, LEMS has also been associated with non-SCLC, lymphosarcoma, malignant thymoma, or carcinoma of the breast, stomach, colon, prostate, bladder, kidney, or gallbladder.

    • This question is part of the following fields:

      • Respiratory
      15.6
      Seconds
  • Question 10 - Which of the following vaccines do not contain live organisms? ...

    Incorrect

    • Which of the following vaccines do not contain live organisms?

      Your Answer:

      Correct Answer: Polio (Salk)

      Explanation:

      Live virus vaccines include: Vaccinia (smallpox), Measles, Mumps, Rubella (MMR combined vaccine), Varicella (chickenpox), Influenza (nasal spray), Rotavirus, Zoster (shingles) and Yellow fever. Inactivated vaccines are Polio (IPV), Hepatitis A and Rabies.

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Rheumatology (0/2) 0%
Neurology (1/1) 100%
Cardiology (1/2) 50%
Respiratory (0/2) 0%
Infectious Diseases (0/1) 0%
Pharmacology (0/1) 0%
Passmed